Design: A randomized controlled trial.

Setting: The outpatient and inpatient departments of three hospitals.

Subjects: One hundred and twenty patients with clinically diagnosed schizophrenia with predominantly negative symptoms were included in the study.

Intervention: All 120 patients were randomly assigned to double-blind treatment with WSKY group (n = 60) or placebo group (n = 60) added to risperidone for eight weeks.

Main measure: The efficacy measures included the World Health Organization Quality of Life Scale (WHOQOL-100), the Positive and Negative Syndrome Scale (PANSS), the Social Disability Screening Schedule and the Hamilton Rating Scale for Depression. Safety and tolerability were assessed throughout the trial.

Results: The scores of quality of life in the WSKY group showed statistically significant improvement at the end-point of treatment compared with those in the placebo group (WSKY, increasing 40.5 (29.4); placebo, increasing 14.4 (27.1); F =24.900, P<0.001), while the scores of social function and depression symptoms also showed statistically significant improvement. The response rates for the WHOQOL-100 total scores were 50.0% for the WSKY group versus 31.7% for placebo group ( ² = 4.172, P=0.041). There were no significant differences in the safety/tolerability measures between the WSKY group and the placebo group during treatment.

Conclusions: The results suggest that WSKY added to risperidone significantly improved the quality of life, social function, depression symptom compared with placebo added to risperidone.

Design: This study was a randomized controlled trial with blinded outcomes assessment and a six-month follow-up.

Subjects and setting: Participants were older adults (>65 years) using a mobility aid discharged from a tertiary hospital in Brisbane, Australia, without referral for community-based rehabilitation services.

Intervention: A digital video disk-based programme encompassing six exercise types each with six levels of difficulty. A home visit from a project physiotherapist was conducted to ensure patient safety. Control group patients received usual care.

Main measures: Falls, health-related quality of life, participation in activities of daily living, physical capacity and fear of falling.

Results: Study participants (n = 53, 19 intervention, 34 control) experienced decreasing health-related quality of life, several falls (72), and lower levels of participation in activities of daily living over the six-month follow-up. The intervention group did not differ significantly from the control group in terms of the outcomes examined, though a non-significant reduction in the rate of falls was observed. Intervention group participants complied with the exercise programme well during the first two weeks following discharge from hospital but then reduced their compliance levels thereafter.

Conclusions: The intervention may be beneficial for reducing the rate of falls in this patient population though further research with a larger sample size is indicated.

Design: Randomized controlled study.

Setting: Residential cardiac rehabilitation centre and community hospital. Intervention: One month of intensive exercise and risk reduction therapy including educational sessions, a low-fat diet, and 2 hours of individually prescribed exercise daily. Control subjects received usual care. Subjects were evaluated at baseline, after completing the one-month residential programme and six years later.

Subjects: From an original study group of 50, 16 patients (8 exercise, 8 controls) with chronic heart failure were alive and available for evaluation after six years.

Main measures: Cardiopulmonary exercise test responses and ventricular size and function using MRI.

Results: Peak Vo₂ was 20.0 and 12.4% higher after the rehabilitation programme and six years later, respectively, whereas minimal changes were observed among controls. Left ventricular mass and volumes tended to decrease among subjects in the exercise group, whereas left ventricular mass and volumes tended to increase among control subjects after six years. Ejection fraction increased approximately 20% in both groups.

Conclusion: Six years after participation in a concentrated residential rehabilitation programme, exercise capacity was preserved and no significant changes were observed in ventricular size or function. These findings provide further support for exercise rehabilitation in chronic heart failure.

Design: A controlled trial.

Setting: Cardiac rehabilitation service of a provincial hospital.

Subjects: Eighty men 2—3 weeks after an acute coronary syndrome, with good exercise tolerance.

Interventions: Three-week, inpatient cardiac rehabilitation programme (control group) supplemented with Nordic Walking (Nordic Walking group), or with traditional walking training (walking training group).

Main measures: Exercise capacity was assessed as peak energy cost (in metabolic equivalents) in symptom-limited treadmill exercise test, and physical fitness with the Fullerton Functional Fitness Test.

Results: Exercise capacity after the rehabilitation programme was higher in the Nordic Walking group than in the control group (10.8 ± 1.8 versus 9.2 ± 2.2 metabolic equivalents, P =0.025). The improvement in exercise capacity in the Nordic Walking group was higher than in the control group (1.8 ± 1.5 versus 0.7 ± 1.4 metabolic equivalents, P =0.002). In contrast to the control group, the results of all components of the Fullerton test improved in the Nordic Walking and walking training groups. After the programme, lower body endurance, and dynamic balance were significantly better in the Nordic Walking group in comparison with the walking training and control groups, and upper body endurance was significantly better in the Nordic Walking and walking training groups than in the control group.

Conclusions: Nordic Walking may improve exercise capacity, lower body endurance and coordination of movements in patients with good exercise tolerance participating in early, short-term rehabilitation after an acute coronary syndrome.

Design: Pilot randomized controlled trial.

Methods: Thirty physiotherapists involved in stroke management were randomized into two groups and participated in five tutor-guided educational sessions (the Physiotherapists’ Educational Programme on Clinimetrics in Stroke, PEPCiS). Groups differed from each other with respect to tutors: one experienced and one inexperienced in stroke care. Primary outcome was ‘actual use’ (the frequencies of data of seven recommended outcome measures in the patient records of the participating physiotherapists).

Results: The actual use of instruments shifted from a median of 3 to 6 in the expert tutor group and from 3 to 4 in the non-expert tutor group (P = 0.07). Physiotherapists educated by the expert tutor used a broader variety of instruments and appreciated the educational programme, their own knowledge gain and all three scales of tutor style aspects significantly more than their colleagues of the non-expert tutor group (all P<0.05). Univariate analysis on the entire set of data revealed eight factors, including tutors’ performance, that were associated with a change score of the use of two or more outcome measures by individual physiotherapists after the educational programme.

Conclusion: In this pilot trial it was not proven that tutor expertise in stroke care influences the actual use of outcome measures, but it warrants a future study with sufficient power to investigate the influence of the tutor.

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 or clinical utility of measures of walking and mobility in adult neurological conditions. Measures with ‘good’ psychometrics and 9/10 clinical utility scores were recommended.

Results: Seventeen measures were selected. Of these, the 5-m and 10-m walk tests, six-minute walk test, High Level Mobility Assessment Tool (HiMAT) and the Rivermead Mobility Index (RMI) reached the required standards and are usable in clinical practice. None of the recommended measures assessed wheelchair mobility. The least frequently assessed property was sensitivity to change. Further measures could be recommended if the minimal detectable change were demonstrated.

Conclusion: The 5-m, 10-m and six-minute walk test, High Level Mobility Assessment Tool and the Rivermead Mobility Index are psychometrically robust measures of walking and mobility and are feasible for use in clinical practice.

Setting: Outpatient physiotherapy department in a local hospital and a local rehabilitation clinic.

Participants: One hundred and twenty patients with chronic pain in physiotherapy treatment.

Methods: Each participant was asked to complete the Chinese version of the Pain Self-Efficacy Questionnaire, visual analogue scale (VAS), modified Roland Morris Disability Questionnaire, and Short Form Health Survey (SF-36). The test structure of the Pain Self-Efficacy Questionnaire was evaluated by confirmatory factor analysis. Highly correlated paths were added onto the initial structure for improving the final construct for the Pain Self-Efficacy Questionnaire. The correlations between the Chinese Pain Self-Efficacy Questionnaire and related measurements were computed using Pearson product-moment correlation coefficients.

Results: Confirmatory factor analysis indicated that the one-factor model provided the best fit between the model and data, with the chi-square of the respecified model computed to be 36.79 (33, N = 120), the goodness-of-fit index 0.940, cumulative fit index 0.996, and the root mean square error of approximation 0.031. The item-total correlations ranged from 0.70 to 0.85. Cronbach’s alpha of the Chinese version of the Pain Self-Efficacy Questionnaire was computed to be 0.94. The total scores also correlated significantly with the modified Roland Morris Disability Questionnaire and six subscales of SF-36.

Conclusion: A single-factor model confirmed the unidimensionality of the Chinese version of the Pain Self-Efficacy Questionnaire in a sample of Chinese patients with chronic pain. It demonstrated good internal consistency reliability and construct-related validity.

Design: A quantitative questionnaire study with two time points: at the beginning of rehabilitation and at six-month follow-up. Multiple regression analyses were used to determine the contribution of demographic/amputation factors versus psychosocial factors to adjustment outcomes.

Setting: A regional outpatient specialist mobility and rehabilitation centre in the UK.

Subjects: Participants were recruited as a consecutive sample of new referrals with lower limb amputation.

Main measures: Age, gender, level and cause of amputation were recorded. The following measures were used: Hope Scale, Multidimensional Scale of Perceived Social Support (MSPSS), Trinity Amputation and Prosthetic Experiences Scale (TAPES) pain subscale initially and the Positive and Negative Affect Scale (PANAS) and full TAPES at six-month follow up. The measures were administered by two specialist nurses.

Results: Ninety-nine patients provided data at both time points. Hope at the beginning of rehabilitation was related to positive mood (P<0.001) and hope and social support were related to general adjustment (P<0.01, P<0.001) at follow-up. Demographic and amputation factors were not related to psychological adjustment outcomes in this study.

Conclusions: The findings demonstrate prospectively the importance of psychosocial variables in the prediction of positive adjustment to lower limb amputation.

Design: Stroke physiotherapists recorded the interventions used to treat postural control and mobility during treatment sessions. They recorded five sessions for at least five patients each. Descriptive statistics assessed the frequency with which the interventions were used.

Setting: Hospital-based acute stroke care.

Subjects: Thirty-six acute stroke physiotherapists recorded 2374 interventions in 364 treatment sessions for 76 patients.

Main measures: The Stroke Physiotherapy Intervention Recording Tool.

Results: Facilitation techniques were the most frequently used interventions (n = 1258, 53%) with exercise (n = 115, 5%), teaching others how to help the patient (n = 99, 4%) and provision of equipment (n = 63, 3%) the least frequently used.

Conclusions: Acute stroke physiotherapists primarily use therapist-led ‘hands-on’ interventions to treat postural control and mobility problems. Interventions to promote activity or practice outside the treatment session are infrequently used.

Objectives: To assess the efficacy of physical exercise for the treatment of depressive symptoms in older adults (>60 years).

Data sources: We searched: MEDLINE (1966—May 2008); EMBASE (1980—May 2008); Cumulative Index to Nursing & Allied Health Literature (CINAHL; 1982—May 2008); PsycINFO (1966—May 2008), The Cochrane Library (Issue 2, 2008), and National Research Register (NRR; Issue 2, 2008).

Review methods: Randomized controlled trials and quasi-experimental studies of physical exercise interventions for depression were included where 80% or more of participants were >60 years. Abstracts were assessed to determine whether they met specified inclusion criteria. Primary analysis focused on the prevalence of diagnosable depressive disorder following intervention. Secondary outcome was depression or mood scores on standardized scales.

Results: Eleven randomized controlled trials with a total of 641 participants were included in the review. Short-term positive outcome for depression or depressive symptoms was found in nine studies, although the mode, intensity and duration of intervention varied across studies. Medium- to long-term effects of intervention were less clear.

Conclusion: Physical exercise programmes obtain clinically relevant outcomes in the treatment of depressive symptoms in depressed older people. Exercise, though not appropriate for all in this population, may improve mood in this group. Further research is needed to establish medium- to long-term effects and cost-effectiveness.

Methods: We searched MEDLINE, CINAHL, PEDro, EMBASE and the Cochrane library from January 1966 to March 2007. Two reviewers independently selected all studies that met predetermined inclusion criteria. Randomized controlled trials that used the Short Form 36 of the Medical Outcome Study (SF-36) questionnaire or the Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO) as outcome measures were selected. The PEDro Scale was applied to rate the quality of each article. All studies had a quality score above 5/10. Meta-analysis was facilitated by RevMan 4.1.

Results: Four randomized controlled trials met the inclusion criteria, involving a total of 256 participants. Results revealed that the exercise groups showed significant improvements in the domains of physical function, pain, role physical and vitality (P<0.05). Furthermore, intervention with combined exercise programmes had better effects on physical function, pain and vitality domains than controls. Group exercise programmes also produced better results in these three domains. A short-duration exercise programme produced more improvement in physical function, role physical and vitality, whereas a long-duration exercise programme resulted in more improvement in physical function and pain domains.

Conclusions: This meta-analysis revealed better improvement in physical function, pain, role physical and vitality in the exercise groups. Combined exercise and group exercise programmes showed better outcomes in the physical function, pain and vitality domains, but different durations of exercise programme showed improvement in different domains.

Design: Single-blind, randomized, controlled trial.

Setting: Two senior service centres.

Subjects: Forty-nine volunteers (14 males and 35 females) aged 62—93 years with up to 12 diagnosed diseases were allocated in either the intervention group (n = 30) or control group (n = 19).

Intervention: The intervention group underwent sound wave therapy, 3—5 times a week for 30 minutes per session over a period of 6 months. The control group received no intervention.

Main measurements: Blood pressure, functional capacity, mobility, bone density, biochemical markers, isometric muscle strength, balance, and skin surface temperature.

Results: Compared with the control group, the intervention group’s mobility and the amount of self-reported kilometres walked per week increased by 3 km (P<0.05), while levels of cholesterol (4.97 (0.72) to 4.52 (0.65) mmol/L, P =0.019), low-density lipoprotein (2.82 (0.72) to 2.45 (0.61) mmol/L, P =0.022), bone markers of total osteocalcin (11.0 (6.5) to 10.3 (5.9) ng/mL, P =0.048)) and tartrate-resistant acid phosphatase isoform 5b (2.50 (1.0) to 2.41 (1.1) IU/L, P =0.021)) decreased. The average skin surface temperature was significantly higher during active sessions at the end of the intervention than in the beginning (P = 0.004). No change was found during placebo sessions.

Conclusions: Low-frequency sound wave therapy may have the potential to promote well-being of frail elderly subjects via improved functional capacity, especially in subjects who are too frail to undertake exercise.

Design: (1) Inter-rater reliability study and (2) responsiveness study with measurements at admission and at discharge from clinical rehabilitation.

Setting: Three rehabilitation facilities in the Netherlands.

Patients: Rehabilitation inpatients (N = 319).

Interventions: Not applicable.

Main outcome measures: Effect size (ES) and standardized response mean (SRM) of USER scales were compared to those of the Barthel Index, Functional Independence Measure (FIM) and to relevant scales of the SF-36.

Results: Inter-rater reliability of USER was satisfactory to good. Strong correlations were found between the physical and cognitive functioning scores of USER, the Barthel Index and FIM (0.84—0.94). Correlations between USER pain, fatigue and mood scores and SF-36 scores were also strong (0.58—0.84). Responsiveness of USER physical functioning (1.0—1.2) was very good and slightly better than responsiveness of the Barthel Index (0.9—1.1) and the FIM motor score (0.8—1.1). Responsiveness of the USER cognitive score was below standard (0.2—0.3), but better than responsiveness of the FIM cognitive scores (0.1—0.2).

Conclusions: USER is a reliable, valid and responsive measure of functional independence that can be used as an alternative for the FIM. The pain, fatigue and mood scores were adapted after this study and need additional validation.

Design: An iterative development process, followed by comparison with systemic prospective activity analysis, and parallel application of prospective and retrospective scores

Setting: A tertiary specialist inpatient neurorehabilitation service

Participants: A total of 37 patients (M:F 21:16, mean age 41.8 (SD 14.7) years) with complex neurological disability in two consecutive cross-sectional cohorts.

Methods: The NPTDA was developed and refined over 18 months, together with an algorithm that converts ordinal scores to estimated therapy hours/week. NPTDA-estimated hours were compared with ‘actual’ therapy hours/week, identified from activity analysis. In a subsequent cohort analysis, prospectively rated NPTDA scores (reflecting intended levels of intervention) were compared with retrospective NPTDA scores (actual interventions).

Results: NPTDA-estimated therapy hours/week were strongly correlated with those identified from activity analysis, for total scores (Spearman rho 0.77, P<0.0001), and also for all five subdomains for direct (hands-on) intervention (rho 0.70—0.93, P<0.0001). The initial test algorithm overestimated therapy hours (Wilcoxon z =3.9, P<0.001). After adjustment, reanalysis using a revised algorithm showed this bias to be removed (Wilcoxon z =1.4 P =0.15). Prospective and retrospectively applied total NPTDA scores were strongly correlated (rho 0.61, P<0.0001). Although intended levels of intervention were higher than those actually delivered (Wilcoxon z =3.30, P<0.001), the differences corresponded to real deviations from intended practice.

Conclusion: In this initial evaluation, after revision of the algorithm, the NPTDA provided acceptable estimate of therapy interventions. Further evaluation is now required in other populations and settings.

Setting: Dutch rehabilitation centre.

Presupposition: The improvement process was considered as a two-way translation process rather than a unidirectional process of knowledge transfer between science and practice.

Method: Case study and participatory research methods comprising documentary analysis, treatment observations, individual and focus groups interviews, and literature studies. A qualitative software program (Atlas-ti) was used to triangulate the collected data.

Results: The main concern of local practitioners was identified to be the post-discharge decline in functional capacity in elderly amputees. This was related to a predominantly biomedical and biomechanical approach, and accompanying traditional therapist—patient interactions. The content and underpinnings of prosthetic treatments were scarcely specified in either the scientific literature or the local setting. Generic principles and practices from other fields were useful for treatment innovation for post-discharge problems, such as task- and context-specific training and self-management education. A circuit training focused on motor learning and a problem-solving training focused on social learning were developed by integrating amputation-specific knowledge.

Conclusion: Improving rehabilitation practice with the use of available evidence is a heterogeneous and multifaceted scientific enterprise. Such an enterprise requires as much self-reflexivity from researchers as from practitioners.

Aim: To suggest strategies and techniques for research in people with aphasia based upon experiences in conducting research in this group of people.

Methods: We conducted a qualitative study and a quantitative study in people with aphasia concerning their social participation. In these studies different strategies were developed based upon the literature, conversations with people with aphasia and speech and language therapists, to facilitate the inclusion of people with aphasia, even those with severe communication problems. Several strategies were evaluated. The strategies used and our experiences are outlined in this report.

Main contribution: It is possible to conduct research in this group. Several strategies were helpful to make this mission possible: the use of pre-structured diaries, the use of in-depth interviews with attention to non-verbal communication, the use of existing measurements, adjusted for people with aphasia by: using pictograms, placing one question per page, bolding the key concepts in the question, using large font, visualizing the answering possibilities in words and in pictures, reducing the question length, and excluding negatives in the question.

Conclusion: Research in people with aphasia is possible when using strategies adjusted to the communicative impairment.

Design: A randomized cross-over pilot study.

Setting: Revive MS Support Therapy Centre. Glasgow, UK.

Subjects: Sixteen people with multiple sclerosis were randomly allocated to one of two groups.

Intervention: Group 1 received four weeks of whole body vibration plus exercise three times per week, two weeks of no intervention and then four weeks of exercise alone three times per week. Group 2 were given the two treatment interventions in the reverse order to group 1.

Main measures: Ten-metre walk, Timed Up and Go Test, Modified Ashworth Scale, Multiple Sclerosis Spasticity Scale (MSSS-88), lower limb muscle force, Nottingham Sensory Assessment and Multiple Sclerosis Impact Scale (MSIS-29) were used before and after intervention.

Results: The exercise programme had positive effects on muscle force and well-being, but there was insufficient evidence that the addition of whole body vibration provided any further benefit. The Modified Ashworth Scale was generally unaffected by either intervention, although, for each group, results from the MSSS-88 showed whole body vibration and exercises reduced muscle spasms (P = 0.02). Although results for the 10-m walk and Timed Up and Go Test improved, this did not reach statistical significance (P = 0.56; P = 0.70, respectively). For most subjects sensation was unaffected by whole body vibration.

Conclusion: Exercise may be beneficial to those with multiple sclerosis, but there is limited evidence that the addition of whole body vibration provides any additional improvements. Further larger scale studies into the effects of whole body vibration in people with multiple sclerosis are essential.

Rationale: Heart rate variability is reduced following a myocardial infarction, and low heart rate variability is associated with a high mortality risk. By changing tidal volume and rate of breathing, individuals can alter beat-to-beat heart rate variability. It is hypothesized that heart rate increases with inspiration and decreases with exhalation, and that deep slow breathing enhances respiratory sinus arrhythmia, increasing heart rate variability.

Design: Randomized controlled trial.

Setting: Cardiac rehabilitation programme at a large academic medical centre in North Texas.

Subjects: From 2001 to 2005, 44 patients, age 46—65 years, who had a myocardial infarction and/or undergone coronary artery bypass graft surgery 1—8 weeks previously and were referred to the Cardiac Rehabilitation Program.

Intervention: Patients were randomized to either usual cardiac rehabilitation or cardiac rehabilitation with controlled breathing (6 breaths/min for 10 minutes twice daily during the eight-week treatment period).

Main measures: Weekly measurements of total power and standard deviation of the mean normal to normal RR interval (SDNN), and fortnightly measurements of respiratory sinus arrhythmia were taken using Biocom Technologies Heart Rhythm Scanner and Tracker software.

Results: No significant difference in change were seen between groups in SDNN (P = 0.3984), baseline respiratory sinus arrhythmia (P = 0.6556) or total power (P = 0.6184).

Conclusion: Results suggest participation in the controlled breathing programme offered no additional benefit in increasing heart rate variability following myocardial infarction or coronary artery bypass graft surgery. However, 77% of study patients were on heart rate-lowering medications, which may have masked changes in heart rate variability.

Design: Pilot study with one-group pre-test post-test design with two pre-tests and one-year follow-up.

Setting: Inpatient rehabilitation hospital.

Subjects: Twelve hemiparetic patients completed the intervention. Ten patients participated at one-year follow-up.

Intervention: Six hours of daily intensive exercise for two weeks with focus on weight-shifting towards the affected side and increased use of the affected extremity during functional activities. An insole with nubs in the shoe of the non-paretic limb was used to reinforce weight-shift toward the affected side.

Main measures: Timed Up and Go, Four Square Step Test, gait velocity, gait symmetry and muscle strength in knee and ankle muscles.

Results: Maximal gait velocity (P = 0.002) and performance time (seconds) on Timed Up and Go (mean, SD; 12.2, 3.8 vs. 9.4, 3.2) and Four Square Step Test improved from pre- to post-test (P = 0.005). Improvements remained significant at follow-up. Preferred gait velocity and gait symmetry remained unchanged. Knee extensor (P<50.009) and flexor (P<50.001) strength increased bilaterally from pre- to post-test but only knee flexor strength remained significant at follow-up. Ankle dorsi flexor (P = 0.02) and plantar flexor (P<0.001) strength increased on paretic side only (not tested at follow-up).

Conclusion: Intensive exercise for lower extremity is feasible in a group setting and was effective in improving ambulatory function, maximal gait velocity and muscle strength in chronic stroke patients. Most improvements persisted at the one-year follow-up.

Design: Randomized controlled trial.

Setting: Hospital neurology and rehabilitation department.

Participants: Sixty-five children with spastic hemiplegic or diplegic cerebral palsy.

Interventions: Botulinum toxin injection guided by electrical stimulation or palpation, and two weeks of physiotherapy.

Main outcome measures: Passive range of movement (ROM), modified Ashworth Scale, Composite Spasticity Scale, D and E dimensions of the Gross Motor Function Measure, walking velocity.

Results: Three groups improved significantly (P<50.05). The mean improvements between baseline and the end of follow-up were respectively 20, 16.2 and 11.9 degrees for passive ROM, —1.9, —1.4 and —0.7 for modified Ashworth Scale scores, —5.8, —4.2 and —2.3 for Composite Spasticity Scale scores, 18.6, 11.3 and 6.9 for Gross Motor Function Measure scores, and 0.2, 0.1 and 0.1 m/s for walking velocity in the botulinum toxin group guided by electrical stimulation injection plus physiotherapy, the botulinum toxin group guided by palpation injection plus physiotherapy, and the physiotherapy only group. The botulinum toxin injection guided by electrical stimulation group showed greater improvement in passive ROM (P<50.05), modified Ashworth Scale scores (P<50.05), Composite Spasticity Scale scores (P<50.05), and Gross Motor Function Measure scores (P<50.05) than the other two groups after treatment for three months.

Conclusions: Botulinum toxin injection guided by electrical stimulation plus physiotherapy is likely to be best in improving spasticity and functional performance in children with cerebral palsy.

Design: Randomized controlled trial.

Setting: An outpatient spine clinic in Norway.

Participants: Twenty-five subjects with a whiplash-associated disorder still having symptoms or disability six weeks after injury.

Interventions: The participants received 6—10 sessions of physiotherapy for six weeks with focus on either motor control or endurance and strength of neck muscles.

Measurements: The primary outcome measure was the Neck Disability Index. Secondary outcome measures were pain intensity, neck functioning and sick leave.

Results: No statistical significant differences concerning primary and secondary outcome measures were demonstrated between the groups. Approximately half of the participants in both groups obtained a clinically important change (improvement) on perceived disability assessed by Neck Disability Index at six weeks and one-year follow-up. The changes within both groups were statistically significant at six weeks, but not at one-year follow-up. For most pain-related variables clinical significant improvement was demonstrated in both groups at six weeks, but for fewer participants at one year. There was also statistical significant improvement within groups in some of the physical performance tests at one-year follow-up.

Conclusion: The changes associated with motor control training and endurance/ strength training of neck muscles were similar for reduced disability, pain and for improving physical performance. With a low number of participants and no control group, however, we cannot be sure whether the improvements are due to interventions or other reasons.

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. Measures with ‘good' psychometrics and ≥9/10 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 usable 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 measurement tools identified above are psychometrically robust and feasible to use in clinical practice. Future objective measure development should consider the theoretical construct of the measure, the minimal detectable change and use in clinical populations other than stroke.

Design: Comparison of physiotherapy staff’s recording of treatment sessions and video recording.

Setting: Rehabilitation stroke unit in a general hospital.

Subjects: Thirty-nine stroke patients without trunk control or who were unable to stand with an erect trunk without the support of two therapists recruited to a randomized trial evaluating the Oswestry Standing Frame. Twenty-six physiotherapy staff who were involved in patient treatment.

Main measures: Contemporaneous recording by physiotherapy staff of treatment time (in minutes) compared with video recording.

Statistical analysis: Intraclass correlation with 95% confidence interval and the Bland and Altman method for assessing agreement by calculating the mean difference (standard deviation; 95% confidence interval), reliability coefficient and 95% limits of agreement for the differences between the measurements.

Results: The mean duration (standard deviation, SD) of treatment time recorded by physiotherapy staff was 32 (11) minutes compared with 25 (9) minutes as evidenced in the video recording. The mean difference (SD) was —6 (9) minutes (95% confidence interval (CI) —9 to —3). The reliability coefficient was 18 minutes and the 95% limits of agreement were —24 to 12 minutes. Intraclass correlation coefficient for agreement between the two methods was 0.50 (95% CI 0.12 to 0.73).

Conclusions: Physiotherapy staff’s recording of duration of treatment time was not reliable and was systematically greater than the video recording.

Design: Cross-sectional, interview-based, psychometric study.

Setting: A community sample from the northwest of England, UK.

Subjects: Fifty-eight carers and 58 stroke survivors with communication problems (aphasia and/or dysarthria) following a stroke within the previous 4—12 months.

Interventions: Administration of the 20-item Carer Communication Outcome after Stroke (Carer COAST) scale, on two occasions, within a two-week period; the 15-item Carers of Older People in Europe (COPE) Index, the patient Communication Outcome after Stroke (COAST) Scale, and collection of demographic and other data relating to the stroke survivor’s disability (Barthel Index), degree of aphasia (Frenchay Aphasia Screening Test) and hospital diagnosis of aphasia/dysarthria.

Main measures: Acceptability (missing values), reliability (internal consistency and test—retest reliability) and construct validity.

Results: Carer COAST showed good acceptability (no incomplete items, sample spread 24—100%), internal consistency and test—retest reliability for the scale (a = 0.94; intraclass correlation (ICC) = 0.91) and its subscales (a = 0.78—0.90; ICC = 0.75—0.87), and indicative evidence on construct validity (Carer COAST, COPE subscales and COAST). There were statistically significant correlations between the communication items of Carer COAST and the negative impact of caregiving (r_s = —0.29) and the financial difficulties of caregiving (r_s = —0.38).

Conclusions: The Carer COAST scale has considerable potential as a reliable and valid measure of the carer’s perspective on the communication effectiveness of stroke survivors. Intercorrelations with COPE provide specific evidence of the impact of caring for a person with communication difficulties following a stroke.

Design: Single-item interview ‘Are you depressed?’ was used as a screening question for depression; all participants then completed the Beck Depression Inventory.

Setting: People with hereditary spastic paraplegia identified from the epidemiological database who agreed to participate in the study.

Main measures: Beck Depression Inventory, clinical interview.

Results: The epidemiological database consisted of 59 patients with clinically confirmed diagnosis of hereditary spastic paraplegia. Forty-eight of these consented to participate in the study. The Beck Depression Inventory score was higher than cut-off point in 58% (28/48) and lower in 42% (20/48). Of the study group, 44% (21/48) had mild, 13% (6/48) moderate and one person revealed severe depression. There was a statistically significant correlation between Beck Depression Inventory score and level of mobility; no other significant correlations with other measures were detected. Of the participants, 54% (26/48) had subjective complaints about depression and answered ‘Yes’ to the single-item interview ‘Are you depressed?’. The sensitivity of the one-item interview in the hereditary spastic paraplegia group was 75% and specificity 75%.

Conclusions: Our results show that mild depression is prevalent among people with hereditary spastic paraplegia. Although the single question may be helpful, it cannot be relied upon entirely when assessing a person for depression.

Data sources: We searched PubMed, CINAHL, EMBASE, Science Citation Index, PEDro, Cochrane Controlled Trails Register and article reference lists.

Review methods: Randomized controlled trials reporting range of motion outcomes of shoulder positioning programmes for patients with stroke were examined independently by the two authors. Studies reporting external rotation range of motion outcomes were abstracted and their quality was rated.

Results: Five studies, all published in 2000 or later, were included. Shoulder external rotation range of motion was lost by control groups (mean = 11.0—18.4^°) and experimental (positioning) groups (mean = 6.1^° to 19.2 ^°) in every study.

The standardized mean difference between groups was -0.216 (95% confidence interval -0.573 to 0.141). These findings and the demonstration of homogeneity between and within groups do not support positioning (as practised) as an effective intervention for preventing or slowing the development of range-of-motion impairments of the paretic shoulder after stroke.

Conclusion: This meta-analysis failed to support the benefit of positioning the paretic upper extremity to prevent or reduce shoulder external rotation range of motion impairments after stroke.

Design: We used a repeated measures design to compare gait performance when unaided and when using the walking glasses with different patterns of visual and auditory stimulation by timing patients' walking over a `real-life' predefined 30-m course.

Setting: Hospital outpatient clinic.

Subjects: Fifteen patients with idiopathic Parkinson's disease who had significant gait problems and no other condition affecting gait performance.

Main measures: Timed walk.

Results: Using the glasses, 8 of 15 patients achieved a significant and meaningful average improvement in walking time of at least 10% (mean (95% confidence interval) improvement in these patients was 21.5% (3.9%)), while a further 2 had subjective and modest objective benefit. Different patterns of visual and auditory cues suited different patients. Visual cueing alone with a fixed horizontal cue line present all the time statistically resulted in the greatest improvement in walking time.

Conclusions: This pilot study shows promising improvement in the gait of a significant proportion of Parkinson's disease patients through the use of a simple, inexpensive and robust design of walking glasses, suggesting practical applicability in a therapy setting to large numbers of such patients.

Design: Assessor-blind within-subject randomised controlled trial.

Setting: Two Australian spinal cord injury units and the community.

Participants: Sixty-four wrists of 32 people with tetraplegia and bilateral weakness of the wrist extensor or flexor muscles (grade 2 - 4 Medical Research Council grades).

Interventions: Participants' wrists were randomly allocated to one of two conditions. Wrist muscles of the experimental arm received electrical stimulation superimposed on progressive resistance training. The wrist muscles of the contralateral arm received sham electrical stimulation superimposed on progressive resistance training. Both arms received 6 sets of 10 contractions three times a week for eight weeks such that the only difference between arms was the application of electrical stimulation.

Main Measures: The primary outcome was maximal voluntary isometric strength. Secondary outcomes were a fatigue resistance ratio representing voluntary and electrically-stimulated endurance. Measurements were taken at the start and end of the eight-week treatment period.

Results: The mean treatment effect (95% Confidence Interval) of electrical stimulation for voluntary strength was 0.04 Nm (95% CI, -0.5 to 0.6; p =0.89). The mean treatment effect (95% CI) for fatigue ratio representing voluntary endurance and electrically-stimulated endurance was -0.01 (95% CI, -0.1 to 0.1; p =0.78) and -0.07 (95% CI, -0.3 to 0.1; p =0.47), respectively.

Conclusions: Voluntary strength of the wrist is not enhanced by the addition of electrical stimulation to progressive resistance training programs in people with tetraplegia.

Methods: Sixteen adults (5 males) diagnosed with patellofemoral pain were studied. The timing of surface electromyography onset and magnitude of vastus medialis obliquus and vastus lateralis contractions were measured during a postero-anterior knee perturbation test. The tests were conducted in random order under three conditions of real taping, placebo taping and no taping. Afterwards, the subjects performed knee extension exercises until fatigue and the above tests were repeated, so as to examine the effects of patellar taping in a muscle fatigued condition.

Results: There was no significant difference in electromyographic onset timing of vastus medialis obliquus and vastus lateralis or in the amplitude of vastus lateralis contraction among the different testing conditions. For vastus medialis obliquus amplitude, however, it was significantly higher in the no taping than the real taping condition regardless of the state of fatigue (P = 0.013).

Conclusions: The present study suggests that patellar taping might not enhance the temporal activation of vastus medialis obliquus in subjects with patellofemoral pain before and after muscle fatigue. Furthermore, vastus medialis obliquus contraction might be inhibited by patellar taping.

Study design: Randomized clinical trial.

Participants: Twenty children aged 7—13 years, with traumatic brain injury (N = 10) or cerebral palsy (N = 10) who were independent ambulators. Five children from each group were randomly assigned to a control group — regular daily activities, or to an experimental group — regular daily activities plus a home-based task-oriented exercise programme of sit-to-stand and step-up exercise, for six weeks.

Outcome measures: Feasibility: The number of participants who completed the programme protocol. Efficacy: Timed Up and Go Test and Functional Reach Test were used as functional balance tests. Maximal isometric strength was assessed by using a hand-held dynamometer; walking performance was assessed by the 10 m walk test, 2-minute walk test and Energy Expenditure Index.

Results: Nine children completed all parts of the training programme. At the end of the intervention period an increase of 3—4 cm in the mean Functional Reach Test and a reduction of 1.6 ± 2.1 seconds in the Timed Up and Go Test were noted (P<0.01) in the experimental group while no changes were noted in the control group. In all other outcomes assessed no significant differences were noted between groups. The positive change in balance performance in the experimental group was maintained during a six-week follow-up period.

Conclusions: A home-based task-oriented exercise programme can improve balance performance in children with spastic cerebral palsy or severe traumatic brain injury.

Design: A cross-sectional study.

Setting: Neurosensory Developmental Unit of a tertiary hospital.

Subjects: Parents of 21 children with motor disabilities were interviewed and scored on the Top Down Motor Milestone Test.

Methods: The subjects were interviewed by one therapist while two other therapists observed the interview procedure. All three therapists were blinded to each other's scores.

Results: Inter-rater reliability was analysed for all the 16 subtests using the inter-rater kappa. The pooled kappa was done for the three raters. The standard error and the P-value were also calculated. The value of inter-rater kappa for individual subtests ranged from 0.74 to 0.96. Pooled kappa for the Top Down Motor Milestone Test was 0.88 with standard error 0.06 and P-value50.01.

Conclusion: The inter-rater reliability of the Top Down Motor Milestone Test proved to be good for each subtest and for the whole test.

Design: Ethnography was used as the framework for research design. Data were collected via participant observation, taped in-depth interviews and regular chart review, and all interviews were transcribed verbatim.

Setting: An inpatient rehabilitation unit in Taiwan.

Subjects: Twenty-one patients, their caregivers and their rehabilitation professionals.

Results: The patients and their caregivers used pluralistic illness explanations and treatments to make sense of their suffering, to control healing and to find the hope that rehabilitation professionals often deliberately avoided giving. Spiritual healing and therapies related to Traditional Chinese Medicine, such as functional food and herbal medicines, were popular alternative therapeutics. Although the patients and their caregivers perceived opposition from the medical staff on the unit, they used a variety of covert strategies to integrate their pluralistic illness explanations and treatments into their daily routines without openly challenging the rehabilitation primacy.

Conclusion: Aware of the rehabilitation staff's opposition, the patients and caregivers resorted to a variety of underground strategies to conceal their use of complementary medical treatments.

Design: Descriptive, comparative.

Main outcome measures: All issues of the AJPMR, APMR, CR and PT between 2003 and 2007 were studied. For each journal, references from articles were consecutively numbered, and using a random number generator, 100 references were selected from each journal. For each reference, ease of retrieval on MEDLINE and the presence of citation errors were noted. If discrepancies were identified, the reference was compared with the original publication. Two observers independently evaluated each reference for citation errors.

Results: The total number of citations with errors among all published journals was 123 (30.7%). The reference error rates by journal ranged from 23% to 44%. Most errors (48.0%) occurred in the author element, followed by the title (31.7%), journal (8.9%), page (5.7%), year (4.1%), and volume (1.6%). Only 8 (2%) were likely to make retrieval of the reference difficult.

Conclusions: Errors in references still appear in current physical therapy and rehabilitation literature, but most are not severe.

Design: Prospective controlled parallel group design.

Setting: Outpatient clinic and community.

Subjects: Thirteen ambulatory people with neuromuscular disease and 18 ambulatory controls.

Main measures: Heart rates were recorded during sedentary activity and treadmill walking at various speeds to indicate activity threshold (flex heart rate), followed by ambulatory heart rate monitoring over two weekdays and one weekend day. The EPIC-Norfolk Physical Activity Questionnaire-2 and Barriers to Physical Activity and Disability Survey were completed.

Results: Participants with neuromuscular disease were less active than controls as estimated by both the EPIC-Norfolk Physical Activity Questionnaire-2, P<0.004, and the flex heart rate method, P<0.05. The number of perceived barriers was greater in the neuromuscular group, a mean of 7 (SD 4.2) barriers, compared with mean 3 (SD 2.1) barriers for controls, P<0.05. Specific barriers differed, with the barriers of `pain', `lack of energy' and `exercise is too difficult' showing the greatest discrepancy and being higher in the neuromuscular disease group.

Conclusion: Physical activity, as determined by two different methods, was less and barriers to exercise greater in people with neuromuscular disease compared with healthy controls. Specific barriers were different in the two groups. This information could assist in the design of achievable and effective exercise programmes for people with neuromuscular disease.