RESUMEN
OBJECTIVES: This study aimed to determine effects of lymphatic drainage therapy (LDT) on autonomic nervous system (ANS) responses by comparing including Hoffmann reflex (H reflex), heart rate variability (HRV), salivary alpha-amylase (sAA) and muscle tone (via straight leg raise (SLR)) in healthy participants. METHODS: A single blind randomized controlled trial evaluating sixty-six healthy participants including 58 females and 8 males aged between 40 and 65 years. All participants were blinded and randomized to either experimental group (EXP: LDT) or control group (CT: rest). LDT was applied to participants 45 min in experimental group. The LDT is light movement applied by an experienced physical therapist, starting from neck, deep abdomen, and along to the leg. While for the control group, participants received 45 min supine on the treatment table. Tests for evaluating ANS such as Hoffmann reflex (H reflex), heart rate variability (HRV), salivary alpha-amylase (sAA) and straight leg raise (SLR) were assessed at pre and post intervention. RESULTS: The findings demonstrated that H reflex decreased significantly after applying LDT; within and between groups (p < 0.05). Whereas, it increased significantly in control group. First tension (R1) indicated by participants during SLR significantly improved within both groups. However, there were no significant differences of HRV and sAA in either LDT or control groups. CONCLUSION: This study demonstrated that LDT decreased autonomic activity via decreased spinal reflex excitability and tension in healthy participants.
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Sistema Nervioso Autónomo , Adulto , Anciano , Femenino , Voluntarios Sanos , Frecuencia Cardíaca , Humanos , Masculino , Persona de Mediana Edad , Método Simple CiegoRESUMEN
BACKGROUND: Evidence-based practice (EBP) enhances healthcare services and keeps providers current with best practices. EBP has been adopted and spread worldwide. However, people will not apply it if they do not know, understand, or believe it. Few studies have considered EBP application in Viet Nam. This study explores whether Vietnamese physical therapists' attitude, knowledge, skills toward EBP and barriers to its use make them ready to implement its practice. METHODS: A survey questionnaire was sent directly to physical therapists in governmental healthcare organizations in Ho Chi Minh City, Viet Nam, from July to October, 2017. It consisted of 41 closed- and open-ended questions related to knowledge, attitude, behaviors, frequency of use, and barriers of EBP and the demographic characteristics of participants. Descriptive statistics and significant correlations were determined from Chi-Square statistics or odds ratios between the variables. RESULTS: The return rate was 93% (421 out of 453). Eliminated were 40 responses inconsistent with inclusion criteria. The 381 eligible participants were more female (62%) than male, about 53% had vocational degrees, less than 1% had M.S. degrees. Participants reported a positive attitude toward EBP. An incongruity existed between knowledge/ skills of EBP and the frequency of using its 5 steps. English competence was the most critical barrier to applying EBP. The significant associations between attitude and knowledge, and demographical attributes indicated that younger therapists with lower educational degrees had less knowledge of EBP and they rarely employed the application and analytical steps 4 and 5. CONCLUSIONS: The incongruity between knowledge and use of EBP may result from the lack of EBP in academic education. The skills of reading professional articles in the English language and understanding and applying the steps of EBP should be emphasized in academic physical therapy programs. Additionally, policy makers should consider the number of patients a day per physical therapist which impacts EBP use and the quality of healthcare service.
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Actitud del Personal de Salud , Competencia Clínica , Práctica Clínica Basada en la Evidencia , Fisioterapeutas , Especialidad de Fisioterapia/educación , Adulto , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Persona de Mediana Edad , Fisioterapeutas/educación , Encuestas y Cuestionarios , Vietnam , Adulto JovenRESUMEN
OBJECTIVE: To determine the correlation between percent weight transfer on paretic limb while standing and the Fugl-Meyer lower extremity motor assessment scale (FMA_LE) in individuals after stroke. MATERIAL AND METHOD: Individuals after stroke who had limited community ambulation and walking speed less than 0.8 m/s were included in the study. Lower extremity motor control was measured in all participants by the FMA _LE and weight transfer onparetic limb while standing on bathroom scales in three directions (lateral,forward and backward). The percent weight transfer on the paretic limb (%WTpar) was the maximum of weight transfer in each direction divided by total body weight. Pearson's correlation coefficient was usedfor statistical analysis. RESULTS: Forty-four individuals after stroke aged 61.27 +/- 12.09 years volunteered to participate in the present study. Their walking speed and FMA LE were 0.37 +/- 0.21 m/s and 18.95+4.11 scores. The %WTpar scores while standing in each direction were 64.15 +/- 13.30% for lateral, 58.20 +/- 13.35% for forward and 61.10 +/- 10.52% for backward. A significant correlation was found between %WTpar in backward direction and FMA LE (r = 0.38, p = 0.001). CONCLUSION: The weight transfer on the paretic leg in backward direction could be used as a clinical assessment tool to identify lower extremity performance in individuals after stroke. To minimize the gap of the ordinal scale in FMA_LE, assessment with metric units should be added. Weight transfer assessment while standing on bathroom scales in different directions provided continuous data and should be added to determine lower extremity motor assessment in individuals after stroke.
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Extremidad Inferior/fisiopatología , Accidente Cerebrovascular/complicaciones , Soporte de Peso/fisiología , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Postura , Caminata/fisiologíaRESUMEN
OBJECTIVE: To determine the immediate effect of hold-relax (HR) stretching of the iliopsoas muscle on pain, transversus abdominis (TrA) activation capacity, lumbar stability level, lumbar lordosis angle and iliopsoas muscle length in chronic non-specific low back pain (CNSLBP) with lumbar hyperlordosis. MATERIAL AND METHOD: Participants aged from 30-55 years with CNSLBP with lumbar hyperlordosis were divided in two groups: (Group 1) Intervention group received 10-second isometric contraction ofthe iliopsoas muscle (HR), 10-second rest, 20-second static stretch, 5 repetitions. (Group 2) control group received 15 minutes resting in supine lying. The visual analog scale, prone test with the pressure biofeedback unit, modified isometric stability test, aflexible ruler and modified Thomas test were usedforpre- and post-test. Two-way ANOVA was used for within and between-group comparisons. RESULTS: The present study consisted of 20 participants. Significant differences were found in pain, TrA activation capacity, lumbar lordosis angle and iliopsoas muscle length between intervention and control groups and between pre- and post-test for intervention group (p<0.05). Lumbar stability level showed no significant difference in within and between-group comparisons. CONCLUSION: The HR of the iliopsoas muscle reduced pain and lumbar lordosis angle, enhanced TrA activation, and increased length of hip flexor in CNSLBP with lumbar hyperlordosis.
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Terapia por Ejercicio/métodos , Lordosis/fisiopatología , Dolor de la Región Lumbar/terapia , Músculos Abdominales/fisiología , Pared Abdominal/fisiología , Adulto , Femenino , Humanos , Dolor de la Región Lumbar/fisiopatología , Región Lumbosacra , Masculino , Persona de Mediana Edad , Músculo Esquelético/fisiología , Dimensión del DolorRESUMEN
OBJECTIVE: To determine the correlation between pressure pain threshold (PPT), displacement pain threshold (DI) and pain visual analog scale (VAS) in patients with delayed onset muscle soreness (DOMS) and myofascial pain syndrome (MPS). MATERIAL AND METHOD: PPT and DPT were measured in the same time by modified Algometer commander. This study used the algometer for measuring PPT (N/cm2), in three groups of subjects, including DOMS (n=10), MPS (n=10), and asymptomatic (n=10). The DPT represented the displacement of the algometer probe on the skin in millimeters, while measuring PPT The DOMS was induced in the non-dominant biceps brachii muscle. The subjects with active myofascial trigger point (MTrP) at the upper trapezius muscle were recruited into the MPS group. DOMS group rated pain by VAS during elbow movement, while the MPS group rated at resting. Spearman's rank coefficient of correlation was usedfor data analysis. RESULTS: The results showed correlation between PPT and DPT in the asymptomatic biceps brachii muscle (r = 0.77, p = 0.001) andDOMS group (r(s) = 0.65, p = 0.04). No correlation wasfound between MPS and the asymptomatic upper trapezius muscle. CONCLUSION: A correlation was found between PPTandDPT in biceps brachii muscles. Thisfinding suggested that to assess the DOMS, the PPT and DPT accurately are requiredfor identifying pain and tissue softness.
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Músculo Esquelético/patología , Mialgia/fisiopatología , Síndromes del Dolor Miofascial/fisiopatología , Umbral del Dolor/fisiología , Adolescente , Adulto , Brazo , Estudios Transversales , Femenino , Humanos , Masculino , Dimensión del Dolor/métodos , Presión , Adulto JovenRESUMEN
OBJECTIVE: To examine the timed up and go (TUG) and tandem walk test (TWT) as fall prediction assessments in Thai elderly. MATERIAL AND METHOD: Elderly subjects aged between 60 and 86 years and living in Nakhonpathom and Samutsakhon provinces were classified as fallers and non-fallers by self-report in the past six months. The TUG and TWT were used to predict falls. The optimal cutoff score and validity indexes were determined by plotting the receiver operating characteristic (ROC) curve and crosstabs analysis. RESULTS: One hundred and sixty-one elderly subjects were classified as fallers (7 males and 43 females) and non-fallers (24 males and 87 females). The area under the curve (AUC) of ROC were 0.62 (95% CI = 0.59, 0.76; p = 0.0001) for TUG and 0.605 (95% CI = 0.514, 0.696; p = 0.033) for TWT error score. The cutoff scores were 10.5 seconds for TUG (74% sensitivity and 57.7% specificity) and five scores for TWT error (62% sensitivity and 55% specificity). CONCLUSION: TUG and TWT error were useful tools to explain faller status in Thai community-dwelling for theelderly. TWT time was not sensitive enough to detect the elders who were at risk of falls.
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Accidentes por Caídas/estadística & datos numéricos , Caminata/fisiología , Anciano , Anciano de 80 o más Años , Estudios Transversales , Prueba de Esfuerzo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Curva ROC , TailandiaRESUMEN
OBJECTIVE: The present study examined the effect of light touch on the preparation for fall-induced protective stepping in elderly and young individuals. MATERIAL AND METHOD: The subjects were perturbed with forward pull with no-touch and light touch conditions. Anticipatory periods, lift-off onset, center of pressure displacement and velocity were measured and analyzed. RESULTS: The authors observed a stabilizing effect during with light touch in pre-perturbation periods. During the perturbation, the elderly took steps earlier than did the young individuals by reducing anticipatory periods; however, their anterior stability limit was similar to that of the youth, indicating that the step was pre-selected. In the youth, a delay in anticipatory onset and shorter periods were observed with light touch, resulting from a limitation in lateral limb loading. Additionally, the stabilizing effect in the pre-perturbation period did not influence stabilization of preparatory period before stepping. In the elderly, shorter anticipatory periods and lower stability limits were also shown in light touch conditions. The authors concluded that the elderly were more concerned with a postural task than with light touch. CONCLUSION: Protective stepping is reflected in the state of balance stability and involves a pre-selection process. Light touch enhances postural stability in stance and impacts the stepping.
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Equilibrio Postural/fisiología , Tacto/fisiología , Caminata/fisiología , Accidentes por Caídas , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Persona de Mediana Edad , Adulto JovenRESUMEN
AIM: To determine if the findings at month 1 could correctly identify stroke patients who fell in the 6 months post-stroke; and to describe the characteristics of fallers and non-fallers, and their courses of recovery. METHODS: Of 133 volunteers who had their first stroke, 98 participants completed the assessment three times. Fall incidence and history were collected by telephone every 2 weeks and recorded. Fear of falling measured by the Fall Efficacy Scale (FES-S), the amount of time that physical therapy was received, and standardized outcome measures according to the International Classification Functioning, Disability and Health model were measured at month 1, 3 and 6 after stroke. The Berg Balance Scale, Barthel Index, Timed Up & Go, 10-m (10mWT) and 2-min walks and participation subscore of Stroke Impact Scale were used for assessment. RESULTS: A total of 25 patients (25%) fell in the 6 months; 13 had multiple falls. Fallers showed less improvement in impairments, activity and community participation compared with non-fallers. The risk of falling was greater than 1 (odds ratio [OR]) when assessed by all outcome measures at month 1, and was double at month 3. The FES-S ≥ 33 at month 1 could accurately identify a faller (OR 2.99, 95% confidence interval 1.07-8.37), moderate to high sensitivity (76%), specificity (49%), and positive and negative predicted value (34% and 85%). CONCLUSIONS: Fear of falling was the best indicator of falling. Receiving physical therapy after a stroke seems to highly contribute to improved functional independence of activities in daily living, and increased self-confidence and cognitive function.
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Accidentes por Caídas/estadística & datos numéricos , Actividades Cotidianas , Miedo/psicología , Medición de Riesgo/métodos , Accidente Cerebrovascular/complicaciones , Evaluación de la Discapacidad , Estudios de Seguimiento , Humanos , Incidencia , Modalidades de Fisioterapia , Equilibrio Postural , Estudios Prospectivos , Factores de Riesgo , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/fisiopatología , Rehabilitación de Accidente Cerebrovascular , Tailandia/epidemiología , Factores de TiempoRESUMEN
Participation in the community socially by stroke victims is an optimal outcome post-stroke. We carried out a cohort study to evaluate a model for community participation by Thai stroke victims 6 months post-stroke. Six standardized instruments were used to assess the patient's status 1, 3 and 6 months after stroke. These were the modified Rankin Scale, the National Institute of Health Stroke Scale, the Fugl-Meyer Assessment and the Berg Balance Scale. The performance of activities of daily living and community ambulation were measured using the Barthel Index and walking velocity. Participation in the community was measured by the Stroke Impact Scale. The outcomes demographics and stroke related variables were analyzed using the Generalized Estimating Equations. Of the 98 subjects who completed the follow-up assessment, 72 (86.5%) felt they had more participation in the community 6 months post-stroke. The level of disability, performance of independent activities and length of time receiving physical therapy were associated with the perceived level of participation in the community among stroke victims 6 months post-stroke. To achieve a goal of good participation in the community among stroke victims, health care planning should focus on improving the stroke victim's ability to independently perform daily activities. The average length of physical therapy ranged from 1 to 6 months, at 3 to 8 hours/month. Clinical practice guidelines should be explored to optimize participation in the community.