Physiotherapy Research Society
28th Scientific Meeting
Measuring Mobility
Thursday 7th May 2009
Glasgow Caledonian University
Physiotherapy Research Society 7th May
Overview
Time and room
0830-0900
2Nd floor CPD
building
0900-1040
CPD 6/7
1040-1110
Open area
11:10: 12:10
CPD 6/7
12:10-1320:
1320-1450
CPD 6/7
1450-1520
Open area
1520-1650
CPD4
CPD6/7
1650
Topic
Registration
Introduction and invited
speakers
Dr. Dawn Skelton:
Professor Lynn Rochester :
Professor Jim Wall
Poster viewing and T-break
Oral presentations on
contemporary physiotherapy
research
lunch break and AGM (CPD
6/7)
Keynotes and 2 short papers
Professor Malcolm Granat
Dr. David Rowe
Poster viewing and T-break
Two concurrent sessions on
contemporary physiotherapy
research
Prize winners and close
The Physiotherapy Research Society
Would like to thank the following for their
generous support of this meeting:
Detailed programme
Location: Rooms 6,7 and 4CPD building, Glasgow Caledonian
University
0830-0900 registration and coffee : Second floor CPD building
Introduction and Keynotes: Location: CPD 06/07
0900-0910: Introduction: Margaret Grant, Head of Physiotherapy, School, Health and
Social Care
0910-0940 Dr. Dawn Skelton: Outcome measurements in falls prevention
0940-1010 Professor Lynn Rochester : Measurement of mobility in Parkinson’s
Disease
10:10: 1040 Professor Jim Wall: Using the internet to measure mobility
10:40-11:10 Break + poster viewing Sponsored by Balancemaster
Posters
1) The effect of lower limb fatigue on obstacle clearance during steady state walking. M.Shiels and
A.Kerr.
2) The effect of physiotherapy based education on the attitudes and beliefs of students towards
individuals with chronic low back pain. C. Ryan, D. Murphy, M. Clarke, A.Lee
3) An investigation into the use of 3 walking related outcome measures for chronic Myelopathy. A.
Adonis, G.P. Taylor
4) The biopsychosocial predictors to self-management post stroke. A. Kahraman, F. Jones, G.
Ellison, R. Harris
5) The Ulster back together project; part 1 – user involvement in the development of an evidencebased low back pain assessment tool. S.M. Liddle, M. Sinclair , P. Nicholl, H.A. Brown, J.G.
Wallace
6) How to measure balance in clinical practice. L.A. Connell, S.F Tyson
11:10: 12:10 Oral presentations on contemporary physiotherapy research
Location: CPD06/07
Validity of an optical proximity sensor (OPS) to measure foot clearance during swing.
D. Rafferty, A.Kerr, P, Dall, G. Hendry, E. Hyslop
Standing on textured surfaces alters mediolateral postural sway in healthy older
people
A.L. Hatton, J. Dixon, K. Rome, D. Martin
Client and therapist experiences with exercise programmes for early-mid stage
Parkinson’s disease and Huntington’s disease
L. Quinn, H, Khalil, K. Jones, S. Richardson, A. Rosser, H. Morris, M. Busse
A pilot study investigating MSc Rehabilitation Science students perceptions of older
adult rehabilitation
G. McCoy, F. Moffat
12:10-1320: lunch break and time for AGM (1240-1320)
Keynotes and short papers
Location: CPD06/07
1320-1350 Professor Malcolm Granat; Measuring Physical activity
1350 1420: Dr. David Rowe: Physical Activity in Children; The Who, How, What,
and Where.
1420 14:50: Oral presentations on contemporary physiotherapy research
The relationship between change in function and change in psychosocial parameters
in individuals with chronic low back pain ]
C.Ryan, W. MacLaren, M. Granat
Measuring mobility with inertia measurement units
J.H.M. Bergmann R.E., Mayagoitia, I.C.H., Smith
14:50 – 1520 Break sponsored by Later Life Training & poster voting (PRS
committee)
15:20 - 1650 Concurrent sessions: Contemporary Physiotherapy Research
Room CPD 06/07
Room CPD 04
Functional
assessment
to
compare
The Prevalence of urinary incontinence
1520conventional
and
computer
navigated
total
Al.Busaidi, N.K. Briffa, J.R., Center
1535
1535
1550
1550
1605
1605
1620
1620
1635
1635
1650
knee arthroplasty
J.R. Smith, P.J. Rowe, M. Blyth, B. Jones
Patient reported outcome differs to
assessment of physical function following
total knee arthroplasty
D.F. Hamilton, AHRW Simpson, P. Gaston
Non-concurrent strength and endurance
rehabilitation improves short term functional,
neuromuscular and sensorimotor outcomes
following both autologous chondrocyte
implantation (ACI) repair of chondral lesions
and anterior cruciate ligament (ACL)
reconstruction
NP Gleeson, AK Bailey, D. Rees, SN
Roberts, JB Richardson
“Explain pain” education and exercise classes
compared to “explain pain” education alone,
for individuals with chronic low back pain: A
single-blind RCT, pilot study
C. Ryan, H Gray, M Newton, M Granat
Strength testing using hand-held
dynamometry of hip flexor, extensor and
abductor muscles following hip resurfacing
arthroplasty: an investigation of inter-rater
reliability
MA Newman, KRB Duffy, J Sheehan, K
Reilly, KL Barker
Prognostic indicators for successful
prosthetic rehabilitation in older
unilateral transfemoral amputees
J. Cumming, K. Rome, V. Whittaker
The effect of functional electrical
stimulation (FES) on the energy
expenditure of overground walking in
people with multiple sclerosis
L. Miller
The impact of home-based
physiotherapy interventions on
breathlessness during activities of daily
living in severe COPD: A systematic
review
M. Thomas, J. Simpson, R. Riley, E.
Grant
Variability of stride length with
walking speed in free living conditions
J. Ross, S. Chastin
Factors associated with reduced health
status in people with peripheral
neuropathies
R. Stockley C. M. White
1650: close Prize winners sponsored by Delsys and ActivePal and next meeting
details
Dr Dawn Skelton:
Outcome Measurements in Falls Prevention
Dr Dawn Skelton is the Scientific Co-ordinator of ProFaNE (Prevention of
Falls Network Europe) at the University of Manchester, UK and Reader in
Ageing and Health for HealthQWest at Glasgow Caledonian University. Her
background research has centred around exercise in older people. Her main
interests lie in the prevention of dependence and the prevention of falls. She
is a commissioned author for the World Health Organisation Health Evidence
Network, the Department of Health and is the Scientific Advisor for the Society
for Physical Activity and the Prevention of Osteoporosis, Falls and Fractures
and the British Heart Foundation National Centre for Physical Activity. She
strives also to get research evidence into practice and is a co-developer of the
UK's only national, accredited specialist exercise training course for Exercise
in the Prevention of Falls and Injuries, developed for physiotherapists,
exercise instructors and other health and leisure professionals.
Key References:
2008. ZIJLSTRA A, UFKES T, SKELTON DA, LUNDIN-OLSSON L,
ZIJLSTRA W. Do dual tasks have an added value over single tasks for
balance assessment in fall prevention programs? Gerontology 54:40-49
2007. SKELTON DA, TODD C. Prevention of Falls Network Europe: A
Thematic Network aimed at introducing good practice in effective falls
prevention across Europe. Three years on. Journal of Musculoskeletal and
Neuronal Interactions 7(3):273-278
2005. SKELTON DA, DINAN SM, CAMPBELL MG, RUTHERFORD OM.
Tailored Group Exercise (Falls Management Exercise - FaME) reduces falls in
community-dwelling older frequent fallers (an RCT). Age and Ageing 34: 636639.
2005. Lamb S, Jorstad-Stein E, Hauer K, Becker C, on behalf of the
Prevention of Falls Network Europe and Outcomes Consensus Group.
Development of a Common Outcome Data Set for Fall Injury Prevention
Trials: The Prevention of Falls Network Europe ConsensusJAGS. Volume 53
Issue 9 Page 1618.
Prof Lynn Rochester:
Measurements of Mobility in Parkinson’s Disease
Lynn Rochester Grad Dip Phys; PhD (UK) recently moved to Newcastle
University where she is Professor of Human Movement Science in the Clinical
Ageing Research Unit and is member of the Institute of Ageing and Health.
She graduated as a physiotherapist and specialised in neuro-rehabilitation
before completing her PhD. She is a member of the Research Advisory Panel
of the UK Parkinson's Disease Society and the Scientific Trust of the
Chartered Society of Physiotherapy. She has a special interest in movement
science, neuro-rehabilitation and Parkinson's disease. Her main research
interests are concerned with motor control of gait, motor learning and the
complex interactions of non-motor and motor symptoms and their
consequences on independent mobility. Her studies include the development
and testing of interventions to improve mobility in Parkinson's disease,
application of novel technologies for assessment and intervention and
development of sensitive measures for improved diagnosis. Her work has led
to the development of clinical therapeutic guidelines to facilitate translation of
research findings into clinical practice and an educational focus ensures that
research is communicated widely to clinicians, students and service users.
Prof Jim Wall:
Using the Internet to Measure Mobility
Qualifications:
BSc in Chemistry & Physiology, Queen Elizabeth College, University of
London
MSc in Biomechanics, University of Surry
PhD Crystallography, Birkbeck College, University of London
MEd, University of Toronto
Employment:
Professor, Department of Physical Therapy, University of South Alabama
Research Interest:
Assessment of functional mobility.
Real Interest:
Chelsea
Prof Malcolm Granat:
Measuring Physical Activity
Malcolm Granat’s research has been broadly divided into three main areas.
The first has principally been concerned with the development of functional
electrical stimulation (FES) based systems for the restoration of movement in
neurological conditions such as spinal cord injury, stroke and cerebral palsy.
The second area has been the clinical evaluation of novel therapies
principally, although not exclusively, involving the use of electrical stimulation
and the third has been the development of novel instrumentation and outcome
measures in support of the broad aims of the first two areas.
Malcolm Granat is presently engaged in a number of programmes looking at
quantification of free-living activity in a range of populations and conditions. In
addition he is exploring the use of activity monitoring as an aid to decision
making for health care professionals. He is also engaged in FES research
projects including a programme investigating the use of FES augmented
partial body weight supported treadmill training for incomplete paraplegics in
the early stages of rehabilitation.
Dr David Rowe:
Physical Activity in Children; The Who, How, What and Where
David Rowe is Reader in the Department of Sport, Culture and the Arts at the
University of Strathclyde and an adjunct professor in the Department of
Exercise and Sport Science at East Carolina University, Greenville NC (USA).
His first degree was a BEd (Hons) in physical education from the University of
Worcester, followed by 10 years teaching primary and secondary physical
education and English in schools in Britain, the Bahamas and Switzerland.
David then completed a master of science in health science at Springfield
College, Massachusetts (birthplace of basketball!) and a PhD in measurement
and exercise science at the University of Georgia (home of the Bulldogs!). He
has taught previously at Middle Tennessee State University, East Carolina
University and the University of Glamorgan.
Teaching interests
David has taught undergraduate and postgraduate classes in research
methods, measurement and statistics. He has also taught various classes
related to physical activity and health. For 6 years, he was degree director of
an undergraduate degree (BSc, Health Fitness Specialist) that received
official endorsement by the American College of Sports Medicine.
Research interests
David's primary research interests are in the areas of physical activity, obesity
and health. He is especially interested in measurement issues, specifically
validity and reliability questions pertaining to physical activity, fitness and
health. He has conducted studies in various age groups from young children
to older adults, and recent research projects have investigated the validity of
obesity classification, the use of pedometers to measure 'healthy' walking,
and field measures of body fatness in school settings.
Abstracts
1. VALIDITY OF AN OPTICAL PROXIMITY SENSOR (OPS) TO MEASURE FOOT
CLEARANCE DURING SWING.
D. Rafferty, A. Kerr, P. Dall, G. Hendry and E. Hyslop
All Glasgow Caledonian University
Introduction: Current methods for measuring foot clearance are limited by their use of a treadmill, inability to
capture multiple steps and confinement to a laboratory. Given that variation in this parameter is considered a factor
in the incidence of trip falling it’s measurement in the field over multiple steps would be an important advance.
The development of a wireless optical proximity sensor (OPS) has opened up the opportunity for this kind of data
collection. Consequently this study aimed to test the validity of an OPS through comparison with a motion capture
system.
Methods: Following ethical approval 15 subjects aged 33.1 (+/-10) years, height 174 (+/-6.4) cm and weight 75
(+/-12.2) kg walked at three velocities (preferred, slow and fast). An OPS was placed on the medial aspect of shoe,
ensuring that the OPS was parallel to the floor, and a reflective marker placed on it’s outer casing. The marker was
tracked with a motion analysis system sampling at 50Hz. The lowest point of the foot during the swing phase was
recorded from each system and these data compared using ICCs.
Results: There was excellent agreement between the two systems. ICCs of 0.925 (all speeds), 0.931 (preferred),
0.966 (slow) and 0.889 (fast) were recorded.
Conclusion: These results represent a strong agreement between the two systems in measuring the lowest point
during swing. The OPS could thus be used instead of cameras to record foot clearance, opening up opportunities
for data collection over long periods of time and in natural settings.
2. CLIENT AND THERAPIST EXPERIENCES WITH EXERCISE PROGRAMMES FOR EARLYMID STAGE PARKINSON’S DISEASE AND HUNTINGTON’S DISEASE
L Quinn, H. Khalil, K. Jones, S. Richardson, A. Rosser A, H. Morris, M. Busse
Cardiff University,
Background and aims: Physiotherapists (PT) and occupational therapists (OT) frequently prescribe home exercise
programs for individuals with Parkinson’s Disease (PD) and Huntington’s Disease (HD), however little is known
about clients’ perceptions of such programs and any barriers that may affect participation and compliance. This
study aimed to capture the attitudes and experiences of people with early-mid stage HD and PD, and with
therapists who have experience in neuro-degenerative diseases. Method: An exploratory, qualitative design was
used. A purposeful sample of PTs (n=8) was recruited through the local Physiotherapy Research Network. Five
individuals with HD and five with PD (n=10) were recruited from specialist research databases. Two focus groups
were conducted for the therapists; individual interviews were conducted for clients with HD and PD. The decision
as to when sufficient participants had been involved was related to when theoretical saturation was achieved. All
conversations were digitally recorded and transcribed verbatim, and transcriptions were analyzed using grounded
theory and validated through researcher triangulation. Results: Concepts were categorized according to emerging
themes and the findings were verified by participants. Therapists and participants believed that exercise is
beneficial for people with PD and HD. Both groups cited several barriers to engagement in exercise programs,
which included disease-specific impairments, individual safety, and the location at which exercising takes place
(home vs. center-based). Therapists specifically felt that a patient’s cognition could affect their ability to
participate in an independent exercise program. Therapists and clients offered a number of different strategies to
overcome barriers to exercise.
Support: This study was funded by chief medical officer for Wales research budget with additional support from the
physiotherapy research society.
References:
1- Busse M, Khalil H, Quinn L, Rosser A. Physical Therapy Intervention for People With Huntington Disease. Phys Ther. 2008;
88 (7):820-31 Polite DF, Hungluer BP. Nursing research: principles and methods. Philadelphia: Lippincott.; 1999. Carter S,
Henderson L.
Approaches to qualitative data collection in social science. In: Bowling A, Ebrahim S, editors. Handbook of Health Research
Methods: Open University Press; 2005.
3. A PILOT STUDY INVESTIGATING MSC REHABILITATION SCIENCE STUDENTS
PERCEPTIONS OF OLDER ADULT REHABILITATION
G. McCoy & F Moffat
Glasgow Caledonian University
Background and Purpose: Scotland’s population is ageing thus increasing the burden on a health service of which
adults over 65 are already principle users. The Scottish Executive recognises rehabilitation as key to meeting
healthcare needs of older adults with the physiotherapy profession integral to this. Little is known about student
Physiotherapists attitudes toward working in this specialty. This study aimed to explore their attitudes and
perceptions toward older adult rehabilitation. Methods: An inductive qualitative study was carried out within the
framework of Interpretative Phenomenological Analysis (IPA). Five female and one male second year MSc
Rehabilitation Science students participated in a focus group. All participants had undertaken a four week clinical
placement in the area of Older Adult Rehabilitation. Findings: Three themes were identified: influences on
student’s perceptions, complexity of older adults and status of older adult rehabilitation. Student’s perceptions
were influenced by factors including their personal interests, site facilities and clinical educators. Despite positives
being taken, particularly interaction with older adults, and a realisation of its complexity, overall this setting had
lower status than other specialities and was viewed as having fewer opportunities for professional progression.
Employment in this setting was considered on a rotational basis, but was unlikely to be a priority career choice.
Conclusion: Within this group of students, older adult rehabilitation languishes behind other specialties in terms of
popularity and perceived professional development. Issues in relation to: negative preconceptions, influence of
clinical educators, measurement of improvements and curriculum development need to be explored
References:
Bloor, M.& Wood F., 2006. Keywords in Qualitative Methods. 1st ed. London. Sage. Department of Health, 2001a Caring for
Older People: A nursing priority. London, The Stationary Office. Greenbaum, T.L., 1998. The Handbook for Focus Group
Research. 2nd ed. California. Sage. Lookinland, S., & Anson K., 1995. Perpetuation of ageist attitudes among present and future
health care personnel: Implications for future care. Journal of Advanced Nursing, 21, 47-56. Nosse, L.J., & Wilson M, 1994.
Geriatric and student physical therapists' attitudes toward elderly individuals. Issues on Aging, 7, 13-15. Nosse, L.J., 1995.
Predicting who will work with elderly patients. Issues on Aging, 18, 15-18. Sheffler S.J., 1995. Do clinical experiences affect
nursing students' attitudes toward the elderly? Journal of Nursing Education, 34(7),312-316.\r\nWade, S., 1999. Promoting
quality of care for older people: Developing positive attitudes to working with older people. Journal of Nursing Management, 7,
339-347.
4. THE RELATIONSHIP BETWEEN CHANGE IN FUNCTION AND CHANGE IN
PSYCHOSOCIAL PARAMETERS IN INDIVIDUALS WITH CHRONIC LOW BACK PAIN.
C. Ryan, W. MacLaren, M. Granat
Glasgow Caledonian University
Introduction: Change in psychosocial parameters is associated with change in self-reported function in individuals
with chronic low back pain (CLBP). It has not been shown if changes in these psychosocial parameters are
associated with changes in objective measures of functioning. Aim: To investigate the relationship between change
in psychological parameters and change in subjective and objective functional measures in individuals with CLBP.
Method: Function and psychosocial measures were assessed pre and post an intervention for individuals with
CLBP (n=31). The psychological variables were collected using standardised questionnaires; Pain self-efficacy
scale, Modified Zung depression index, Modified somatic perceptions questionnaire, the Tampa scale of
Kinesiophobia fear and harm subscales, and a Pain numerical rating scale. Function was measured using selfreport (The Roland Morris Disability Questionnaire) and estimated energy expenditure measured using the
activPAL™ activity monitor. Two stepwise regression analyses were used to assess the relationship between
change in both function markers and psychosocial variables. Ethical approval was obtained for this study. Results:
The greater the improvement in pain self-efficacy and depression the greater the improvement in self-reported
function (p<0.05). There was a direct relationship between change in fear of harm and energy expenditure
(p=0.01), however, the direction of the relationship was counterintuitive with greater improvements in fear or harm
associated with a smaller increase in EE. Conclusion: Changes in psychosocial variables were associated with
changes in subjective and objective markers of functioning in individuals with CLBP. The direction of the
relationship depended on the functional measure used.
5. MEASURING MOBILITY WITH INERTIA MEASUREMENT UNITS
J.H.M Bergmann, R.E. Mayagoitia, I.C.H.Smith
King’s College London
In self-rated health, the most important activities of daily living are those involving mobility [1]. Obtaining
accurate data about mobility is therefore clinically relevant. Self-reported difficulty in stair climbing has shown to
be useful in assessing and defining functional status of older adults [2], while basic mobility is often assessed by
the Timed Up and Go test (TUG) [3]. In general, kinematics and biomechanical aspects of stair climbing are
studied using laboratory staircases and optical motion analysis systems. Although this kind of research yields
valuable information, the results only remain valid when no anticipation or reaction to a real-world environment is
required. We have measured joint angles and initial contacts during stair climbing (n=14) using a portable system
of inertial measurement units (IMUs) and found that this method related well to measurements obtained with an
optical tracking device (Pearson’s Correlations > 0.92, p< 0.01). Basic mobility was further investigated (n=28) by
using IMUs to measure TUG performance of healthy young and older adults. By utilizing a quantitative method,
we were able to split up the TUG into components (standing up, walking, turning, etc.). We found that turning
time appeared to be the best component to distinguish between the two age groups (ANOVA, Bonferroni, p<
0.01). Whereas, standing up time did not seem to differ between the two groups. In general, we can conclude that
these highly portable body-worn inertial sensors can be used by clinicians and researchers alike, to accurately
collect data regarding mobility in complex real-life situations.
Support: This work was funded by a joint Medical Research Council and Graduate School Studentship of King’s College
London.
References:
1. Valderrama Gama E, Damian J, Perez del Molino J, Lopez M, Perez M, Iglesias F: Short report. Association of individual
activities of daily living with self-rated health in older people. Age and Ageing 2000, 29:267-270. Verghese J, Wang C, Xue X,
Holtzer R: Self-Reported Difficulty in Climbing Up or Down Stairs in Nondisabled Elderly. Archives of Physical Medicine and
Rehabilitation 2008, 89:100-104. Podsiadlo D, Richardson S. The timed "Up & Go": a test of basic functional mobility for frail
elderly persons. J Am Geriatr Soc 1991 Feb;39 (2):142-148.
6. FUNCTIONAL ASSESSMENT TO COMPARE CONVENTIONAL AND COMPUTER
NAVIGATED TOTAL KNEE ARTHROPLASTY
J. Smith1, P.Rowe 1, M. Blyth 2, B. Jones 2
1
HealthQWest, Bioengineering Unit, University of Strathclyde, Glasgow, UK
2
Department of Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK
Purpose: To investigate whether computer navigated Total Knee Arthroplasty (TKA) resulted in an improved
functional outcome when compared to conventional TKA.
Relevance: Literature has reported that computer navigated surgery results in improved post-op alignment 1,2.
However there is limited information on whether navigation and improved alignment relates to functional outcome
3,4.
Subjects:40 patients completed 1 year post-operation functional assessment (24 navigated, 16 conventional). All
patients were recruited from Glasgow Royal Infirmary’s TKA lists and randomised into either conventional and
navigation group.
Method:Flexible electrogoniometry was used to measure knee joint angles during a functional assessment, which
includes activities such as level and ramp walking, stair negotiation and in/out a bath. Max/min and excursion
values were calculated for each patient and average gait cycle charts plotted. An overall functional score was
calculated for each of the patients. The functional assessment also includes calculating quadriceps/hamstring
moments and questionnaire scores such as American Knee Society Score and WOMAC.
Analysis:A t test was used to evaluate between-group differences.
Results:The overall functional score for the 2 groups was not significantly different (p=0.25) but the navigated
mean score was higher than the conventional indicating a trend towards better function in this group which may
become significant with greater numbers. The percentage of patients in the navigated group with mechanical
alignment within the desired range (-/+ 3o) was higher than conventional.
Discussion/Conclusion:Functional outcome scores and post-op mechanical alignment show no statistically
significant differences between the groups but the navigated scores are higher.
References:
1. H. Bäthis et al. Journal of Bone and Joint Surgery Br 86-B: 682-7, 2. M. Bolognesi et al. Clinical Orthopaedics and Related
Research 440: 162-169, 3. M.D. Rossi et al. The Journal of Arthroplasty. 2006; 21(1): 6-12, 4. J.M. Spencer et al. Journal of
Bone and Joint Surgery. (Br) 2007; 89B(4): 477-480
7. PATIENT REPORTED OUTCOME DIFFERS TO ASSESSMENT OF PHYSICAL FUNCTION
FOLLOWING TOTAL KNEE ARTHROPLASTY
DF. Hamilton1, AHRW. Simpson1,2, P. Gaston2
1
University of Edinburgh,2Royal Infirmary of Edinburgh
Purpose: To examine the relationship between physical outcome and patient report of outcome following total
knee arthroplasty (TKA).Relevance: Increasingly Patient Reported Outcome Measures (PROMS) are used to
assess function following TKA. It is assumed that these measures accurately reflect the patient’s pain and physical
function, however, evidence is emerging that this may be incorrect 1,2. Methods: Approval was granted by the
Local Research Ethics Committee, and 26 consecutive patients listed for TKA were assessed pre TKA, and at 8
and 26 weeks post-operation. The Oxford Knee Score (OKS) and the physical function score (PCS) of the Short
Form-36 were utilised as self report outcomes. Direct measurement of leg strength was assessed (Leg extensor
Power Rig TM). Timed assessment of functional tasks was performed (Automated Locomotor Function, ALF).
Pain scores were recorded by numerical rating scale. Results: All the individual measures showed statistically
significant improvement between each of the assessment periods (paired sample t-test, p = <0.05). The PROMS
however were found to correlate poorly to the physical assessments. The OKS correlated poorly with the ALF, (r =
< 0.5) and with leg strength (r = < 0.3).The PCS correlated poorly with ALF (r = < 0.2) and with leg strength (r =
0.34). Conclusions: These results suggest that PROMS do not fully represent actual physical function following
TKA. With the advancement of PROMS in the literature, it is important to recognise that the assessment they
provide may be incomplete. A larger study would be beneficial to assess this issue fully.
Support: This work forms part of a PhD award with is jointly funded by the Medical Research Council and Stryker UK
References:
Stratford. PW, Kennedy. DM, Woodhouse. LJ. (2006) Performance measures provide assessments of pain and function in people
with advanced osteoarthritis of the hip or knee. Physical Therapy 86(11): 1489-1496 Kennedy DM, Stratford. PW, Riddle. DL,
et. al. (2008) Assessing recovery and establishing prognosis following total knee arthroplasty. Physical Therapy 88(1): 22-31
8. NON-CONCURRENT STRENGTH AND ENDURANCE REHABILITATION IMPROVES
SHORT-TERM FUNCTIONAL, NEUROMUSCULAR AND SENSORIMOTOR OUTCOMES
FOLLOWING BOTH AUTOLOGOUS CHONDROCYTE IMPLANTATION (ACI) REPAIR OF
CHONDRAL LESIONS AND ANTERIOR CRUCIATE LIGAMENT (ACL) RECONSTRUCTION.
Gleeson NP 1&3, Bailey AK 2, Rees D 2, Roberts SNJ 2, Richardson JB 2, Eston R 3, Minshull C4
1
Queen Margaret University, 2Robert Jones & Agnes Hunt Orthopaedic and District NHS Trust,
3
University of Exeter, 4 Nottingham Trent University
PURPOSE: To assess the effectiveness of a new formulation of rehabilitation following ACI surgery or ACLreconstruction, involving segregation of strength and endurance exercises to minimise physiological inhibition to
conditioning. DESIGN & METHODS: RCT - Neuromechanical, sensorimotor, musculoskeletal and functional
capabilities were assessed in knee extensor and flexor musculature of involved and contralateral control limbs
prior to either unilateral ACI or ACL-reconstruction surgery; and intermittently to 48 weeks post-surgery in
participants randomly assigned into three groups: (i) CONTROL A, (n=7), accelerated programme of exercise
rehabilitation used in current practice, (ii) CONTROL B, (n=7), quantifying the influence of the test
administrator/assessment procedures, and (iii) EXPERIMENTAL, (n=8) involving a modified programme of
rehabilitation specific phasing of strength and endurance exercises. RESULTS: Results from mixed-model
ANOVA (0 – 12 weeks post-surgery) suggest that whereas the neuromechanical performance associated with the
involved limb of the control group (CONTROL A) showed relatively large deficits compared to baseline (up to
72%, 65% and 82% reduction, respectively in peak force, electromechanical delay, rate of force development, the
performance capabilities of the EXPERIMENTAL group were preserved more effectively during this period of
rehabilitation (up to 35%, 42% and 36% reduction, respectively; F[5, 65] = 3.4; p<0.05). Similarly, sensorimotor
performance capabilities were re-established more rapidly (F[5, 65] = 3.6; p<0.05). Accumulating data suggest
similar short-term enhancements to patterns of recovery following ACI surgery. CONCLUSION: The findings
show that segregation of strength and endurance exercises within early phases of rehabilitation programmes may
minimise attenuation of performance capabilities following surgery and facilitate optimised recovery.
Support: Institute of Orthopaedics, Robert Jones & Agnes Hunt Orthopaedic and District NHS Trust, Oswestry, UK School of
Sport & Health Sciences, University of Exeter, UK
9. “EXPLAIN PAIN” EDUCATION AND EXERCISE CLASSES COMPARED TO “EXPLAIN
PAIN” EDUCATION ALONE, FOR INDIVIDUALS WITH CHRONIC LOW BACK PAIN: A
SINGLE-BLIND RCT, PILOT STUDY.
C. Ryan, H. Gray, M. Newton, M. Granat
Glasgow Caledonian University, Glasgow,.
Introduction: “Explain pain” education and exercise classes are two widely used interventions for individuals with
chronic low back pain (CLBP). The aim of this study was to investigate the effect of these two strategies when
used in combination. Methods: Thirty-eight individuals with CLBP were randomly assigned to the education and
exercise (EDEX) group [n=20] or the education only (ED) group [n=18]. The education consisted of a single three
hour “Explain pain” session. The exercise classes consisted of six weekly sessions of physiotherapist led “Back to
fitness” exercise classes. Pain, function, activity monitoring, physical performance testing and a range of
psychosocial outcome measures were assessed pre and post treatment and at three month follow-up (except
activity monitoring). Results: Post treatment, 50 foot walk (10.76 vs. 9.00 seconds, p = 0.03) and 5 minute walk
test performance (434 vs. 491 meters, p = 0.06) were greater in the ED group. There was also a higher level of
function (6.0 vs. 2.5, p = 0.08) and a lower level of pain (12.5 vs. 1.3, p = 0.08) in the ED group. Within groups,
from pre-to-post intervention, the ED group significantly increased their physical activity levels (8040 vs. 9165
steps/day, p = 0.01), but the EDEX group did not (8329 vs. 8927 steps/day, p = 0.17). There was no statistical
difference between groups at three month follow-up. Conclusions: A single “explain pain” education session may
be superior to a combination of “explain pain” education and exercise classes, in the short-term, for individuals
with CLBP
10. STRENGTH TESTING USING HAND-HELD DYNAMOMETRY OF HIP FLEXOR,
EXTENSOR AND ABDUCTOR MUSCLES FOLLOWING HIP RESURFACING
ARTHROPLASTY: AN INVESTIGATION OF INTER-RATER RELIABILITY.
M.A.,Newman, KRB. Duffy, J. Sheehan, K. Reilly, KL. Barker.
Nuffield Orthopaedic Centre
Purpose: To assess inter-rater reliability of muscle strength measures obtained with a hand held dynamometer
(HHD) following hip resurfacing arthroplasty (HRSA). Relevance: Reliable strength assessment after HRSA is
essential to quantify impairments, plan rehabilitation and assess outcomes [1]. Manual testing has limitations;
HHD is an alternative with reliability established for varied conditions [2]. However reliability is linked to the
population studied and the reliability of HHD is unknown in this population. Subjects: Twenty four people
attending a review following HRSA participated; 8 women and 16 men mean age 57 (SD 7.6), 11 right, 13 left.
Methods: Three measures of hip flexor, abductor and extensor strength were made using a Lafayette HHD by 2
physiotherapists independently 15 minutes apart on one occasion. A standard protocol was used that incorporated
a ‘make’ test, positioning, instructions and dynamometer placement. Analysis: Data was analysed using both intraclass correlation coefficients (ICCs) and Bland and Altman plots. The first and mean of the 3 measures were
compared. Results: All ICCs were above 0.75 suggesting good reliability [3]. ICCs of mean measures were higher
than first measures: flexors 0.86 (CI: 0.69-0.94), abductors 0.93 (CI: 0.85 -0.97) and extensors 0.90 (CI: 0.770.96). Average bias in measures was small: mean difference flexors -1.4, abductors -0.8, extensors-1.9 but 95%
limits of agreement suggested moderate variability, particularly for hip flexors. Conclusion: HHD appeared a
reliable method of assessing hip strength after HRSA. Using the mean of 3 measures, a make test and standard
protocol to reduce random error is recommended.
References:
1. Newman MA, Barker KL, Pandit H, Murray DW. Outcomes after metal-on-metal hip resurfacing: Could we achieve better
function? Archives of Physical Medicine and Rehabilitation 2008; 89:660-9. Kolber MJ, Cleland JA. Strength testing using hand
held dynamometry. Physical Therapy Reviews 2005; 10: 99-112. Sim J, Wright C. Research in Health Care: Concepts, designs
and methods. 2000; Nelson Thornes, Cheltenham.
11.STANDING ON TEXTURED SURFACES ALTERS MEDIOLATERAL POSTURAL SWAY IN
HEALTHY OLDER PEOPLE
1
1
A.L Hatton1, 1J. Dixon, 2K. Rome, 1D. Martin
University of Teesside, 2 AUT University, New Zealand
Purpose: To investigate whether standing on textured surfaces alters postural sway variables and lower limb
muscle activity in healthy older adults. Relevance: Previous studies have shown balance can be improved by
surfaces with texture compared to those that are smooth [1,2]. Textured footwear interventions can also influence
lower limb muscle activity, possibly by providing enhanced sensory input [3]. No study has investigated the effect
of texture on postural stability and lower limb muscle activity in older people. Subjects: 50 healthy older adults (29
female); mean (SD) age 75.1 (5.0) were investigated. Methods: Ethical approval was granted by the School of
Health & Social Care Research Governance and Ethics Committee at the University of Teesside. Anteriorposterior and mediolateral sway variables and lower limb EMG intensity in five muscles were collected
synchronously over 20 seconds of bipedal standing, with eyes open and closed, under three randomised conditions;
Control, Texture 1, Texture 2. Analysis: One-way repeated measures ANOVA Results: Texture 1 significantly
reduced mediolateral sway range compared to control, when standing quietly with eyes closed. Mean (95%
confidence interval) difference between these surfaces was 1.7 (0.2 to 3.3) mm. No such effects were seen in
anterior-posterior sway or lower limb EMG activity, for either visual condition. Discussion: Textured surfaces can
improve standing balance in healthy older people. Alterations in balance were not accompanied by any detectable
changes in lower limb muscle activity. The potential to help reduce the risk of falling in older people using
textured surfaces requires further investigation.
Support:Funding: Dunhill Medical Trust / British Geriatrics Society Fellowship
References:
1. Corbin D, Hart J, Palmieri-Smith R, et al. The effect of textured insoles on postural control in double and single
limb stance. J Sport Rehabil. 2007;16:363-372. Watanabe I, Okubo J. The role of plantar mechanoreceptors in
equilibrium control. Ann N Y Acad Sci. 1981;77:855-877. Nurse M, Hulliger M, Wakeling J, et al. Changing the
texture of footwear can alter gait patterns. J Electromyogr Kinesiol. 2005;15:496-506.
12.THE PREVALENCE OF URINARY INCONTINENCE
Al Busaidi K1, Briffa NK1, Center JR2
1
School of Physiotherapy, Curtin University of Technology, Perth, Westrern Australia, 2Bone and Mineral Research Program,
Garvan Institute of Medical Research, St Vincent\'s Hospital, University of New South Wales, Sydney, NSW, Australia
Background and Aims: The aim of this study was to investigate the prevalence and risk factors for UI in Omani
women, as they are currently unknown. Methodology: 120 women aged 18 years from randomly selected
households in the Muscat region of Oman were invited to participate. 118 women (mean age 39.1) agreed. Data
were collected ،door-to-door، using a valid and reliable questionnaire developed for the study. Data were analysed
using logistic regression analysis. Result: 52.5% had urinary incontinence (UI); 28% stress UI, 11.9% and urge UI
and 12.7% mixed UI. Factors significantly associated with UI in bivariate analyses were sneezing related to allergy
ƒ‫ث‬OR 7.1; 95%CI 2.2-22.4ƒ‫ح‬, obesity (2.2; 1.05-4.7), lower urinary tract symptoms (2.3; 1.02-5.2), and chronic
cough (3.8; 1.005-14.4). Age, menopausal status, parity, diabetes, circumcision, diuretic use, and coffee
consumption were not associated with UI. In forward stepwise logistic regression analysis with all significant risk
factors included as independent variable, only sneezing was a significant predictor of UI. Conclusion: There was a
high prevalence of UI among Omani women in Muscat. The strong relationship between allergy with sneezing and
urinary incontinence is a novel finding that has not previously been documented as a risk factor for UI in
population based studies. The risk factors associated with UI were generally amenable to health education and
treatment suggesting excellent potential for the burden of UI to be reduced in this group of women. Key Words:
Epidemiology, Prevalence, Urinary incontinence, Omani women.
13. PROGNOSTIC INDICATORS FOR SUCCESSFUL PROSTHETIC REHABILITATION IN
OLDER UNILATERAL TRANSFEMORAL AMPUTEES
Jane Cumming 1, 2, Keith Rome 3, Vicki Whittaker 2
1
The James Cook University Hospital, Middlesbrough, England; 2The University of Teesside, Middlesbrough, England.3The
University of Auckland, New Zealand
The aim was to develop profiles of older (60 +) transfemoral prosthetic limb users to inform prosthetic provision.
Older unilateral transfemoral amputees (OTFAs) do not achieve a high level of prosthetic mobility or function
(Cumming, et al 2006). However, success rates published are very variable. OTFAs (n=206) referred to the
Prosthetic Centre between 2000 and 2005 were included in this mixed history retrospective cohort study.
Relationships between clinical, social and demographic variables and outcomes including level of mobility and use
of prosthesis were explored. The primary measure of success was based on mobility outcomes and usage at 6
months. Data was abstracted from case notes. Analysis (SPSS) was mainly descriptive and comparative.
Regression analysis was applied. 53/206 were relatively successful in independent mobility. Many (n=38) stopped
limb wearing by 6 months; significant variables (p<0.05) were particular co-morbidities; >8 medications, low preamputation mobility, low Barthel index (<12), delayed casting and dysvascular aetiology. Full time limb wearing
at 6 months correlated to fewer co morbidities, higher previous mobility. Mobility and use of prosthesis in OTFAs
is generally poor and very few achieve useful ambulation. The author was able to formulate prognostic indicators
for likely success applicable to assessment and practice. OTFAs have a low success rate in useful walking ability.
Good pre-amputation mobility, fewer co-morbidities, low dependence and recovery of independence post
amputation are major positive indicators. Alternative modes of mobility such as powered chairs may offer greater
independence and re-integration into community life.
14. THE EFFECT OF FUNCTIONAL ELECTRICAL STIMULATION (FES) ON THE ENERGY
EXPENDITURE OF OVERGROUND WALKING IN PEOPLE WITH MULTIPLE SCLEROSIS
Paul L1, Young S2, Rafferty D2, Miller L3, Mattison P3, McFadyen A4
1
University of Glasgow, 2 Glasgow Caledonian University, 3 NHS Ayrshire and Arran, 2Glasgow Caledonian University
Purpose/relevance: Functional Electrical Stimulation (FES) is used clinically in the management of drop foot in
neurological conditions. The study investigated the effects of FES on gait speed and energy expenditure, in people
with Multiple Sclerosis (pwMS). Subjects/ methods: Twelve pwMS and 12 healthy matched controls were
recruited. The subjects walked at their own preferred walking speed (PWS) for five minutes around a 10m
elliptical course. PwMS walked with and without using their FES and control subjects also completed the protocol
walking at the same PWS of their matched MS subject. A COSMED K4b2 gas analysis system measured the
percentage of expired oxygen. Ethics approval was granted by NHS Ayrshire and Arran ethics committee.
Analysis: Paired t tests were used to investigate the differences between MS subjects with and without FES and for
controls at their PWS and matched speeds of pwMS. A Bonferroni correction was applied and the alpha level set at
0.025. Results: Wearing FES lead to a significant improvement in walking speed (0.49m•s-1 and 0.43ms-1 with
and without their FES respectively; P<0.001) and a significant reduction in the energy expenditure of walking
(0.41 mL•min-1•kg-1•m-1 and 0.46 mL•min-1•kg-1•m-1 with and without FES respectively; P=0.017) in pwMS.
The speed of walking, oxygen uptake and energy expenditure were significantly different between pwMS and
controls both at preferred and matched speeds. Discussion/Conclusion: Whilst pwMS exhibit a higher energy cost
of walking FES offers an orthotic benefit to pwMS and should be considered as a possible treatment option.
Further research on the functional benefits of FES is required.
15. THE IMPACT OF HOME-BASED PHYSIOTHERAPY INTERVENTIONS ON
BREATHLESSNESS DURING ACTIVITIES OF DAILY LIVING IN SEVERE COPD: A
SYSTEMATIC REVIEW
M.Thomas1, J. Simpson2, R.Riley3, E. Grant2
1
NHS Halton and St Helens, 2University of Liverpool, 3Centre for Medical Statistics and Health Evaluation, University of
Liverpool
Objectives: Systematic review and meta-analysis to determine the impact of home-based physiotherapy
interventions on breathlessness during activities of daily living (ADL) in severe COPD. Data sources: Electronic
databases AMED, CINAHL, Cochrane collaboration database, EMBASE, MEDLINE and PEDro were searched
from inception to May 2008. Bibliographies of potentially relevant retrieved studies, identified relevant systematic
reviews and international guidelines were hand searched. Methods: Inclusion criteria were adults over 18 years
with severe COPD defined as FEV1<50% predicted without cardiovascular co-morbidities, home-based
interventions and valid, reliable breathlessness ADL outcomes measures. The PEDro scale assessed
methodological quality. Data extraction included baseline characteristics, treatment intervention, frequency of
training, level of supervision, breathlessness ADL outcome measure and results. Where possible, a random-effects
meta-analysis was applied to appropriate trial data to produce overall quantitative results. Results: Seven studies,
providing 9 data sets, met inclusion criteria. Trial PEDro scores ranged from 4-7/10. Studies were homogenous at
baseline regarding age and COPD severity, although predominantly male. Five studies investigated inspiratory or
expiratory muscle training (IMT, EMT) and 2 investigated exercises. Statistically significant breathlessness ADL
outcome improvements were found for all interventions expect EMT. Five demonstrated clinical significance, 4
IMT and 1 exercise. Three IMT studies provided sufficient data for meta-analysis, and the pooled result indicates
IMT improves breathlessness score by 2.36 (95% CI 0.76-3.96) compared to control. Conclusion: IMT and
exercise are cost-effective home-based physiotherapy interventions that can improve breathlessness during ADL in
severe COPD; IMT being better substantiated. Administration is advocated in outpatient services and primary
care.
16. VARIABILITY OF STRIDE LENGTH WITH WALKING SPEED IN FREE LIVING
CONDITIONS
J.Ross, S. Chastin
Both Glasgow Caledonian University
Background & Aim: Walking is a voluntary task that appears to be relatively stable from one step to the next.
Studies over the past two decades have revealed the time between consecutive steps, at any instant, is related to or
dependent upon previous steps in healthy adults. In disease and ageing populations the time between consecutive
steps becomes unpredictable. Neurologically diseased and ageing populations generally walk at a slower walking
pace than young healthy adults, and as such could act as a potential confounding variable in gait analysis studies.
This study’s purpose was to determine the effect three different over-ground walking speeds could have on the
variation of consecutive stride interval times. Methods: A convenience sample of 15 young healthy adults were
recruited and the stride interval times of consecutive steps were measured for both legs during 8-10 minutes of
slow, normal and fast over-ground walking using the activPALTM activity monitor. The mean variation between
consecutive stride intervals was calculated at each speed to determine the relationship between mean stride interval
variation and real life over-ground walking speed. Results: The mean variation of consecutive stride intervals
increased with increasing speed. A significant difference was found between slow and fast walking speeds as well
as normal and fast walking speeds (p-value <0.001). Conclusions: There is a significant relationship between
walking speed and mean stride interval variation of consecutive steps. Further to this, stride interval times at faster
walking speeds appear to be more unpredictable than at slower walking speeds.
References:
Goldberger, A.L., Peng, C-K. & Lipsitz, L.A., 2002b. What is physiologic complexity and how does it change with aging and
disease? Neurobiology of Aging, 23, 23-26. Hausdorff, J.M., Peng, C-K., Ladin, Z., Wei, J.Y., & Goldberger, A.L., 1995. Is
walking a random walk? Evidence for long-range correlations in stride interval of human gait. Journal of Applied Physiology,
78(1), 349-358.
17. FACTORS ASSOCIATED WITH REDUCED HEALTH STATUS IN PEOPLE WITH
PERIPHERAL NEUROPATHIES
1
1
R.C. Stockley, 2C.M. White
Manchester Metropolitan University, 2King's College University, London
Purpose: The aim of this study was to investigate associations between health status and other aspects of
functioning in people with peripheral neuropathies (PN). Relevance: People with PN have reduced health status
(Merkies et al. 2002) but the factors that may be associated with poorer health status in this patient group have not
been widely studied. Method: The self reported health status of participants with inflammatory PN was measured
using the short form -36 item questionnaire (SF-36). Other measurements included strength (MRC sum score),
activity limitations (Overall Neuropathy Limitations Scale, ONLS) feelings of fatigue (Fatigue impact scale, FIS),
energy cost whilst walking (EO2) and total activity counts over 5 days (MTI Actigraph). Ethical approval was
provided by the local NHS research ethics committee. Analysis: Associations between health status and other
variables were investigated using Pearson correlation coefficients. Significance was set at p<0.05. Results:
Thirteen PN participants (4 females; CIDP=7, GBS= 4, Other =2) were recruited. Poorer health perception on the
SF-36 was significantly associated with increased physical fatigue (FIS-P; r=0.7). Physical function scores were
strongly associated with the ONLS (r=0.89), strength (r=0.84) and fatigue affecting social activities (FIS-S;
r=0.68). Very strong associations were seen between scores on the SF-36 social function and ONLS, FIS –S and
FIS-P (r> 0.8). Conclusions: Both activity limitation and fatigue are likely to impact significantly on health status
in people with PN. Further work is now necessary to understand fatigue in order to guide treatments to improve
health status in this patient group.
Support: Financial support was provided by the Guy's and St Thomas' Charity.
References:
Merkies IS, Schmitz PI, van der Meché FG, Samijn JP, van Doorn PA; Inflammatory Neuropathy Cause and Treatment (INCAT)
group. Quality of life complements traditional outcome measures in immune-mediated polyneuropathies. Neurology. 2002;59
(1):p 84-91.
POSTERS
18. THE EFFECT OF LOWER LIMB FATIGUE ON OBSTACLE CLEARANCE DURING
STEADY STATE WALKING
M.Shiels, A.Kerr
Division of Physiotherapy, School of Health & Social Care, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4
0BA.
PURPOSE: To determine the effect of lower limb fatigue on obstacle clearance during steady state walking.
RELEVANCE: Lower limb fatigue may have a negative effect on the ability to clear an obstacle when walking
and thus may have implications for falls prevention programmes. SUBJECTS: Six healthy male and six healthy
female subjects participated (mean age 24.2 + 1.5). METHODS: Subjects completed two sessions, the order of
which was randomised. One involved a sub-maximal treadmill test to 80% age predicted maximum heart rate
following the modified Bruce protocol proceeded by obstacle clearance and another session of obstacle clearance
only. A 3-D motion analysis system (Qualisys Pro-reflex) allowed measurement of vertical toe height during gait
by placing reflective markers on the medial and lateral malleoli and the base of the 1st and 5th metatarsal. Heart
rate and rate of perceived exertion were measured before, during and at the end of the test, as indicators of fatigue.
ANALYSIS: A paired t-test was carried out in order to compare obstacle clearance under normal conditions and
after the lower limb had been fatigued. RESULTS: No significant difference (p = 0.329) in toe height was found
between the normal and fatigued condition, indicating that lower limb fatigue had no effect on obstacle clearance
during gait. CONCLUSION: Lower limb fatigue has no effect on obstacle clearance during steady state walking.
However due to the small, healthy sample population there is a risk of a type II error and the relationship between
fatigue and obstacle clearance remains unclear.
19. THE EFFECT OF PHYSIOTHERAPY BASED EDUCATION ON THE ATTITUDES AND
BELIEFS OF STUDENTS TOWARDS INDIVIDUALS WITH CHRONIC LOW BACK PAIN.
C. Ryan, D. Murphy, M. Clarke, A.Lee
All Glasgow Caledonian University
Question: What is the effect of physiotherapy education compared to a non-health care education on the attitudes
and beliefs of students towards functioning in individuals with back pain? Design: Observational study.
Participants: Level 1 physiotherapy (n=61) and non-health care students (n = 61) and level 4 physiotherapy (n =
62) and non-health care students (n = 62). Outcome measures: All participants completed the Health Care
Providers Pain and Impairment Relationship Scale (HC-PAIRS). This questionnaire measures a health care
providers attitude towards functioning in individuals with back pain. P<0.01 was considered statistically
significant. Ethical approval was obtained. Results: Level four physiotherapy students had more positive overall
attitudes towards functioning in individuals with back pain than level one physiotherapy students (66.6 vs. 57.4, 9.2 [95%CI -12.2 to -6.1], p=0.00 [mean difference [95%CI], p-value]). Conversely level one and level four nonhealth care students had similar attitudes (69.2 vs. 65.3, -3.9 [95%CI -7.2 to -0.5], p=0.03). There was no
difference in attitudes between level 1 Physiotherapy and non-health care students (66.6 vs. 69.2, -2.6 [95%CI -5.5
to 0.4], p=0.08), but there was a difference between level 4 Physiotherapy and non-health care students, with the
level 4 physiotherapy students having more positive attitudes (57.4 vs. 65.3, -7.9 [95%CI -11.4 to -4.4], p=0.00).
Conclusion: These findings suggest that physiotherapy based education brings about more positive student
attitudes towards functioning in individuals with back pain when compared to non-health care based education.
This may facilitate physiotherapy students to become more evidence based practitioners with this patient group
post qualification.
20 AN INVESTIGATION INTO THE USE OF 3 WALKING RELATED OUTCOME MEASURES
FOR CHRONIC MYELOPATHY
A. Adonis, G.P. Taylor, G.P
Imperial College Healthcare NHS Trust
Background: Human T-cell Lymphotrophic Virus Type 1 (HTLV 1) Associated Myelopathy (HAM) is a
neurological condition of unknown aetiology. These patients suffer lifelong disability, with restriction in their
quality of life & activities of daily living. Currently there are ongoing clinical trials requiring a robust, clinically
useful tool to measure the effects of any intervention that these patients receive, with meaningful implication for
patient function. Thus far no outcome measures are able to routinely detect change in the patient’s condition. Aim:
Investigation of 3 walking related outcome measures, the 10 metre timed walk (10mTW); Timed Up and Go
(TUAG)& MSWS 12, in HAM patients at 6 time points. Methods: A repeated study design with a single observer,
applied the 3 outcome measures to HAM patients who sequentially attended their HTLV outpatient clinic
appointments Results: 8 patients completed the study. Good correlation existed for 10mTW vs TUAG (R²-0.99).
Increased variability in MSWS 12 scores & poor correlation of TUAG vs MSWS 12 vs 10mTW. None of the
outcome measures showed a clinically significant change (p=<0.05) and potential contributing factors include the
influence of spasticity & pain levels on physical function. Discussion: Robust, clinically useful & sensitive
measurement tools for HAM patients need to take into account the varying factors that may influence the patient’s
functional ability. Despite TUAG;MSWS 12 & 10mTW not showing clinically significant change in the walking
ability, MSWS12 alluded to patient’s perceiving themselves more disabled. Motor components that patients
struggle with were unmasked, this can be masked when doing physical assessments on these patients
References:
1.Podsiadlo D, Richardson S. The Time “Up & Go”: A Test of Basic Functional Mobility for Frail Elderly Persons.Journal of
the American Geriatrics Society 1991; 39(2): 142-148. Shumway Cook A, Brauer S, Woollacott M. Predicting the Probability
for Fall s in Community Dwelling Older Adults Using the Timed Up & Go Test. Physical Therapy 2000 Vol 80(9): 896-903.Hobart, J.C., Riazi, A., Lamping, D.L. Fitzpatrick, R., Thompson, A.J., 2003, Measuring the Impact of MS on walking
ability: The 12-item MS Walking Scale (MSWS – 12), Neurology, 60, pp. 31-36.Franzoi, A.C., Araujo, Q.C.A., 2005, Disability
profile of patients with HTLV-I-associated myelopathy/tropical spastic paraparesis using the Functional Independence Measure
(FIM™), International Spinal Cord Society, 43, pp. 236-240.Araujo, A.Q-C., Silva, M.T.T., 2006, The HTLV-1 neurological
complex, Lancet Neurology, 5, pp. 1068-1076
21. THE BIOPSYCHOSOCIAL PREDICTORS TO SELF-MANAGEMENT POST-STROKE
A. Kahraman, F. Jones, G. Ellison, R.Harris
St George's University of London
Objectives: To determine baseline biopsychosocial predictors to self-management behaviours post stroke.
Background: Stroke has a complex and biopsychosocial recovery trajectory. There is an emerging emphasis on
self-management, which can be associated with positive outcomes for people with chronic conditions, in policy
documents relating to long-term conditions. Stroke is also regarded as a long-term condition. However, there is
minimal evidence on the key factors influencing and predicting self-management in stroke survivors.
Methodology: Two hundred adults who have a clinical diagnosis of a first stroke will be recruited. The participants
will be studied at two time points. At first time point, around the discharge from acute care, the biopsychosocial
data of the participants will be collected and the (1) HADS, (2) mRS, (3) BI, (4) MOS-SSS, (5) SSEQ will be
conducted to assess mood, stroke severity, level of functional independency, social support and self-efficacy scores
respectively. At the second time point, approximately 12 months later, the (1) Self-Management Behaviours
Measure, (2) SSQOL, (3) SSEQ will be administered to participants to measure self-management, quality of life
and self-efficacy respectively. Analysis: Main variables of the study (mood, functional status, social support,
stroke severity, self-efficacy) will be put into a regression model with multiple regression analyses. Discussion &
Implications: The rationale and design for a prospective longitudinal cohort study design determining the
biopsychosocial factors that may predict self-management behaviours post stroke is presented. The findings are
anticipated to provide a better understanding of stroke recovery and facilitate formulation and delivery of better
rehabilitation following stroke.
References:
1.Department of Health (2005), The National Service Framework for Long-term Conditions, London, DH. 2.Department of
Health (2007), National Stroke Strategy, London, DH.3.Epping-Jordan, J.E., Pruitt, S.D., Bengoa, R., Wagner, E.H. (2004)
Improving the quality of health care for chronic conditions, Quality and Safety in Health Care, 13:299–305.4.Jones (2005)
Factors which influence the resumption of activity and participation following stroke, University of Brighton.5.Jones, F. (2006)
Strategies to enhance chronic disease self-management: how can we apply this to stroke?, Disability and Rehabilitation, 28 (1314): 841-847.
22. THE ULSTER BACK TOGETHER PROJECT: PART 1 – USER INVOLVEMENT IN THE
DEVELOPMENT OF AN EVIDENCE-BASED LOW BACK PAIN ASSESSMENT TOOL
SD Liddle, M Sinclair, P Nicholl, HA Brown, JG Wallace;
University of Ulster
BACKGROUND: Low back pain (LBP) is recognised as being a multidimensional condition, resulting in a
variety of treatment approaches. To compare the effectiveness of such treatments, and make recommendations for
future practice, a consistent approach to LBP outcome assessment is imperative (1), a feature currently lacking (2,
3). OBJECTIVE: To involve users in developing an evidence-based electronic LBP data repository capable of
efficiently capturing and collating standardised treatment outcomes. METHOD: The ‘BACK Together’ Project is
a secure website with a data collection interface for patient self-assessment, and a practitioner interface. The site
incorporates the latest evidence on LBP triage, classification and outcome assessment: it is capable of
systematically capturing information about how LBP affects the individual using valid and reliable instruments
such as health-related quality of life, back-specific function, work disability, fear-avoidance and pain. A feedback
loop provides patients and clinicians with current best practice for the management of LBP, and includes an
individual summary of weekly activity levels. To pilot test the user acceptability of the interface and the efficiency
of data collation and presentation, a sample of volunteers (n=25) logged in to, and freely navigated the site.
RESULS: The user-acceptability of both interfaces was largely supported by the sample, with recommendations
given for further improvements. User feedback and recommendations for improvement are presented.
DISCUSSION: Further pilot testing of the tool within the clinical environment will determine its potential for
creating and utilising an evidence base to inform the clinical assessment and management of individuals
experiencing LBP.
Support: Higher Education Innovation Fund - Dept for Employment and Learning
References:1. Resnik L, Dobrzykowski E. Guide to outcomes measurement for patients with low back pain syndromes. Journal
of Orthopaedic and Sports Physical Therapy 2003 33: 307-316. Liddle SD, Gracey JH, Baxter GD. Advice for the management
of low back pain: A systematic review of Randomised Controlled Trials. Manual Therapy 2007; 12: 310-327. Liddle SD, Baxter
GD, Gracey JH. Physiotherapists’ use of advice and exercise for the management of chronic low back pain: a national survey.
Manual Therapy 2009; 14: 189-196.
23. HOW TO MEASURE BALANCE IN CLINICAL PRACTICE?
L.A. Connell, S.F. Tyson
University of Nottingham
Objective: To identify psychometrically robust and clinically feasible measurement tools of balance activity in
people with neurological conditions to recommend for use in clinical practice.
Data sources: MEDLINE, CINAHL, EMBASE, PEDro and AMED
Review methods: Independent reviewers selected and extracted data from articles that assessed the reliability,
validity, sensitivity to change and clinical utility of measures of balance activity in adult neurological conditions.
Quality assessment was based on Jorstad et al (2005). Measures with good psychometrics and clinical utility scores
were recommended.
Results: Nineteen measurement tools were selected. Of these, the Brunel Balance Assessment, Berg Balance
Scale, Trunk Impairment Scale, Arm Raise and Forward Reach tests in sitting and standing, Weight Shift,
Step/Tap and Step-Up tests reached the required standards and are useable in clinical practice. The Brunel Balance
Assessment and its associated functional performance tests have the additional advantages of being a hierarchical
scale with established lack of redundancy. Conclusion: The Brunel Balance Assessment is recommended to
measure balance activity in clinical practice. Future OM development should consider the theoretical construct of
the measure, the minimal detectable change and use in clinical populations other than stroke.
Reference:
Jørstad, E. C., K. Hauer, et al. (2005). "Measuring the Psychological Outcomes of Falling: A Systematic Review." Journal of the
American Geriatrics Society 53(3): 501-510.