Improved Quality of Life, Working Ability, and Patient Satisfaction After a Pretreatment Multimodal Assessment Method in Patients With Mixed Chronic Muscular Pain: A Randomized-controlled Study Multicomponent exercises including muscle power training enhance muscle mass, power output, and functional outcomes in institutionalized frail nonagenarians Randomized Trial of Modified Constraint-Induced Movement Therapy With and Without an Intensive Therapy Program in Children With Unilateral Cerebral Palsy The efficacy of multidisciplinary rehabilitation in stable multiple sclerosis patients Translating measurement findings into rehabilitation practice: an example using Fugl-Meyer Assessment-Upper Extremity with patients following stroke. A randomized trial on the effect of a multimodal intervention on physical capacity, functional performance and quality of life in adult patients undergoing allogeneic SCT Effectiveness of workplace interventions in rehabilitating musculoskeletal disorders and preventing its consequences among workers with physical and sedentary employment: systematic review protocol Development of the Rapid Assessment, Prioritisation and Referral Tool (RAPaRT) for multidisciplinary teams in emergency care settings Progressive multi-component home-based physical therapy for deconditioned older adults following acute hospitalization: a pilot randomized controlled trial The reliability, validity and responsiveness of an aggregated locomotor function (ALF) score in patients with osteoarthritis of the knee. Development and evaluation of a multifaceted ergonomics program to prevent injuries associated with patient handling tasks. The limited value of the Health Assessment Questionnaire as an outcome measure in short term exercise trials. Effects of a multimodal exercise program for people with ankylosing spondylitis. INVITED COMMENTARY: Rating the Quality of Trials in Systematic Reviews of Physical Therapy Interventions Three-Dimensional Motion Analysis Validation of a Clinic-Based Nomogram Designed to Identify High ACL Injury Risk in Female Athletes A multicentre cluster-randomized controlled study to evaluate a train-the-trainer programme for implementing internal and external participation in medical rehabilitation Temporal and spatial control following bilateral versus unilateral training.
Objective : To investigate whether a pretreatment multimodal ( MM ) assessment of patients with chronic muscular pain has an impact on treatment outcome . Methods : The present r and omized-controlled study evaluated an MM assessment compared with routine multidisciplinary assessment given to a control group . The study population consisted of primary care patients with mixed chronic muscular pain . Variables assessed were : pain intensity , depression , life stress , quality of life ( QOL ) , disability , working ability , and treatment satisfaction . Follow-up was performed at 15 months and 182 patients of 220 ( 83 % ) completed the study . Results : Univariate and multivariate logistic regression showed from baseline to 15 months a significant improvement in QOL as measured by Short-Form 36 in the MM group compared with the control group on the domains of physical function ( odds ratio 2.40 ; 95 % confidence interval 1.32 - 4.37 ) , role physical ( 2.37 ; 1.10 - 5.09 ) , and role emotional ( 2.05 ; 1.05 - 3.96 ) . Working ability improved more significantly in the MM group ( 46 % vs. 35 % ) and impairment was less ( 1 % vs. 15 % ) compared with the control group ( P=0.016 ) . Satisfaction with the assessment was , on average , higher ( P<0.001 ) in the MM group than in the control group . Discussion : Patients who underwent an MM assessment before treatment in comparison with patients receiving routine multidisciplinary assessment improved QOL , working ability , and were also significantly more satisfied . This result indicates that MM pretreatment assessment could be advantageous in the selection of patients for suitable rehabilitation treatment in a primary care setting , and also be used to prepare patients for future rehabilitation This r and omized controlled trial examined the effects of multicomponent training on muscle power output , muscle mass , and muscle tissue attenuation ; the risk of falls ; and functional outcomes in frail nonagenarians . Twenty-four elderly ( 91.9 ± 4.1 years old ) were r and omized into intervention or control group . The intervention group performed a twice-weekly , 12-week multicomponent exercise program composed of muscle power training ( 8–10 repetitions , 40–60 % of the one-repetition maximum ) combined with balance and gait retraining .  Strength and power tests were performed on the upper and lower limbs . Gait velocity was assessed using the 5-m habitual gait and the time-up- and -go ( TUG ) tests with and without dual-task performance . Balance was assessed using the FICSIT-4 tests . The ability to rise from a chair test was assessed , and data on the incidence and risk of falls were assessed using question naires . Functional status was assessed before measurements with the Barthel Index . Midthigh lower extremity muscle mass and muscle fat infiltration were assessed using computed tomography . The intervention group showed significantly improved TUG with single and dual tasks , rise from a chair and balance performance ( P < 0.01 ) , and a reduced incidence of falls . In addition , the intervention group showed enhanced muscle power and strength ( P < 0.01 ) . Moreover , there were significant increases in the total and high-density muscle cross-sectional area in the intervention group . The control group significantly reduced strength and functional outcomes . Routine multicomponent exercise intervention should be prescribed to nonagenarians because overall physical outcomes are improved in this population Background . Constraint-induced movement therapy ( CIMT ) has gained emerging evidence and popularity in children with unilateral cerebral palsy ( CP ) . However , many issues remain unanswered regarding the best approach . Objective . This study investigated the additional effects of an intensive therapy program to promote h and function combined with home-based modified CIMT ( m-CIMT ) . Methods . Fifty-one children ( mean age 8 years 9 months ) were r and omized to m-CIMT alone or m-CIMT with intensive therapy ( IT ) . All children had to wear a constraint on the unaffected h and for 1 hour , 5 days/week for 10 weeks . Children in the m-CIMT + IT group also received 3 sessions of 45 minutes weekly of intensive therapy for distal muscle strengthening and h and function , using unimanual and bimanual activities . The Assisting H and Assessment ( AHA ) was the primary outcome measure . Secondary outcome measures were muscle tone , strength , Melbourne Assessment , Jebsen – Taylor test , and ABILH AND -Kids question naire . Assessment s were administered at baseline , after intervention , and at 10-week follow-up . Results . Significant between-group differences in AHA were in favor of the m-CIMT + IT group ( P = .04 ) . Both groups demonstrated comparable improvements in muscle tone ( P = .002 ) , strength ( P < .0001 ) , grip strength ( P = .02 ) , and unimanual capacity ( Melbourne Assessment and Jebsen – Taylor , P < .0001 ) . Younger children and children with poorer h and function benefited from both interventions , whereas older children and children with better h and function only benefited from the combined approach . Conclusions . The combination of m-CIMT with an intensive therapy program on distal h and function and strength enhances the effects of m-CIMT alone for improving bimanual performance Objective To evaluate the short-term efficacy of multidisciplinary , inpatient rehabilitation of multiple sclerosis ( MS ) patients . Methods A double-blind , r and omized , parallel group design was used . The intervention group were offered comprehensive , multidisciplinary inpatient rehabilitation  at the Haslev MS Hospital for an average of 35.5 days , while the control group received no treatment related to the study . All patients were examined in their homes twice with a 10-week interval . The rehabilitation of the intervention group started 2 - 3 weeks after the first examination and ended 2 - 3 weeks before the second examination . Impairment was assessed by the Multiple Sclerosis Impairment Scale and the Exp and ed Disability Status Scale . Disability was assessed by means of Guy ’s Neurological Disability Scale . Two specific scales were used to assess upper limb function and ambulation : The Nine-Hole Peg Test and timed 10-metre walking . Patients ’ own perception of bodily pain , bladder symptoms , spasticity , fatigue , impaired walking and transfers were recorded using visual analogue scales . Finally , quality of life was assessed using the Life Appreciation and Satisfaction Question naire and the Functional Assessment in Multiple Sclerosis . Patients Two hundred and thirty-three patients were screened and of those 38 were included for treatment and 52 as controls . Results We found no statistically significant differences between the two groups in any of the outcome measures . Conclusion Although the study was underpowered , the negative outcome exposes the difficulties in quantitative analyses of the efficacy of multidisciplinary rehabilitation , which is liable to confounding factors such as variation in the indication for treatment , in the placebo effect , and in the reliability and responsiveness of the outcome measures St and ardized assessment s are critical for advancing clinical rehabilitation , yet assessment scores often provide little information for rehabilitation treatment planning . A keyform recovery map is an innovative way for a therapist to record patient responses to st and ardized assessment items . The form enables a therapist to view the specific items that a patient can or can not perform . This information can assist a therapist in tailoring treatments to a patient 's individual ability level . We demonstrate how a keyform recovery map can be used to inform clinical treatment planning for individuals with stroke-related upper-limb motor impairment . A keyform map of poststroke upper-limb recovery defined by items of the Fugl-Meyer Assessment -Upper Extremity ( FMA-UE ) was generated by a previously published Rasch analysis . Three individuals with stroke enrolled in a separate research study were r and omly selected from each of the three impairment strata of the FMA-UE . Their performance on each item was displayed on the FMA-UE keyform . The forms directly connected qualitative descriptions of patients ' motor ability to assessment measures , thereby suggesting appropriate shorter and longer term rehabilitation goals . This study demonstrates how measurement theory can be used to translate a st and ardized assessment into a useful , evidence -based tool for making clinical practice decisions The aim of this r and omized controlled trial was to investigate the effect of a 4- to 6-week multimodal program of exercise , relaxation and psychoeducation on physical capacity , functional performance and quality of life ( QOL ) in allogeneic hematopoietic cell transplantation ( allo-HSCT ) adult recipients . In all , 42 patients were r and omized to a supervised multimodal intervention or to a control group receiving usual care .  The primary end point was on aerobic capacity measured in VO2 max . Secondary end points were muscle strength , functional performance , physical activity level , QOL , fatigue , psychological well-being and clinical outcomes . The multimodal intervention had a significant effect on physical capacity : VO2 max ( P<0.0001 ) and muscle strength : chest press ( P<0.0001 ) , leg extension ( P=0.0003 ) , right elbow flexor ( P=0.0009 ) , right knee extensor ( P<0.0001 ) and functional performance ( stair test ) ( 0.0008 ) . Moreover , the intervention group showed significantly better results for the severity of diarrhea ( P=0.014 ) and fewer days of total parenteral nutrition ( P=0.019 ) . Longitudinal changes in QOL , fatigue and psychological well-being favored the intervention group , but did not reach statistical significance . Assignment of a multimodal intervention during allo-HSCT did not cause untoward events , sustained aerobic capacity and muscle strength and reduced loss of functional performance during hospitalization Background Musculoskeletal disorders ( MSDs ) are the leading cause of work disability and sickness absence worldwide . The prevalence of MSDs increases with age , consequently challenging sustainable employability among the growing ageing workforce . Knowledge of feasible and efficient workplace-based interventions to rehabilitate MSD or prevent its consequences is therefore warranted . This systematic review will evaluate the effectiveness of workplace-based interventions on MSDs and its consequences among adult workers with physical and sedentary work tasks , respectively . Methods We will search the following bibliographic data bases : PubMed ( including the data base ‘ MEDLINE ’ ) and Web of Science Core Collection ( including the data bases ‘ Science Citation Index Exp and ed ’ , ‘ Social Sciences Citation Index ’ and ‘ Arts & Humanities Citation Index ’ ) . Manual search es will also be performed . We will include r and omised controlled trials ( RCTs ) and non- RCTs reported in English in which ( 1 ) participants are adult workers with MSD , ( 2 ) interventions are aim ing at rehabilitating pain symptoms of MSD or preventing the consequences of MSD and ( 3 ) interventions are initiated and /or carried out at the workplace . The review will adhere to the ‘ Preferred Reporting Items for Systematic review s and Meta-Analyses ’ ( PRISMA ) guidelines for reporting systematic review s and the Institute for Work and Health ( IWH ) guidelines for workplace-based interventions . For the primary evaluation of the review , the quality assessment and evidence synthesis will conform to the IWH guidelines . Secondary evaluation will include a meta- analysis ( unless the included studies do not allow this due to heterogeneity ) and employ the risk of bias domains recommended by Cochrane along with the Grading of Recommendations , Assessment , Development and Evaluations ( GRADE ) approach on the studies with pain intensity as an outcome . Discussion This systematic review will provide knowledge on effective workplace-based interventions among physical and sedentary workers with MSD . RCTs are considered the most powerful experimental design in clinical trials , but solely including these may be too restrictive to underst and effective workplace-based interventions where r and omised and carefully controlled trials ( RCTs ) are not always possible . In order to maximize practical relevance , the selection process will , therefore , include both RCTs and non- RCTs and the quality assessment and evidence synthesis will conform to IWH guidelines focusing on developing practical guidelines for stakeholders . The result of this work will form the basis for industry-specific evidence -based recommendations on effective workplace-based interventions for rehabilitation of MSDs and its consequences that will later be operationalised into concrete and user-friendly practical tools for workplaces . Systematic review registration International Prospect i ve Register of Systematic Review s ( PROSPERO ) number CRD42018116752 Objective This investigation utilised the expertise of allied members of multidisciplinary teams working in emergency care setting s to develop and vali date a Rapid Assessment Prioritisation and Referral Tool ( RAPaRT ) . This instrument is intended for use among patients ( with non-life threatening acuity ) presenting to emergency care setting s to indicate when referral to an allied member of the multidisciplinary team is warranted . Method This three stage instrument development and validation study included : a Delphi panel process to determine key criteria to guide instrument development and identify potential items to be carried forward for testing ( stage 1 ) ; a prospect i ve cohort of consecutive admissions ( n=153 ) to investigate item sensitivity and specificity and retain only the most suitable items ( stage 2 ) ; then final consultation with the Delphi panel to ensure the final instrument was clinical ly amenable ( stage 3 ) . Results 23 potential items were identified following stage 1 . At the completion of item sensitivity and specificity analysis and in consultation with the Delphi panel , seven items were retained in the instrument . Area under the receiver operating characteristic curve was 0.803 for these seven items in predicting when a referral was warranted . Final consultation with the Delphi panel members also result ed in the addition of an open ended ( eighth ) item to allow description of any infrequent , but important , reason for referral . Conclusions The RAPaRT has demonstrated substantial promise as an efficient clinical ly amenable instrument to assist multidisciplinary teams in emergency care setting s. Further research to investigate the wider implementation of the RAPaRT is warranted Objective : To determine whether a progressive multicomponent physical therapy intervention in the home setting can improve functional mobility for deconditioned older adults following acute hospitalization . Design : R and omized controlled trial . Setting : Patient homes in the Denver , CO , metropolitan area . Participants : A total of 22 homebound older adults age 65 and older ( mean ± SD ; 85.4 ±7.83 ) ; 12 were r and omized to intervention group and 10 to the control group . Intervention : The progressive multicomponent intervention consisted of home-based progressive strength , mobility and activities of daily living training . The control group consisted of usual care rehabilitation . Measurements : A 4-meter walking speed , modified Physical Performance Test , Short Physical Performance Battery , 6-minute walk test . Results : At the 60-day time point , the progressive multicomponent intervention group had significantly greater improvements in walking speed ( mean change : 0.36 m/s vs. 0.14 m/s , p = 0.04 ) , modified physical performance test ( mean change : 6.18 vs. 0.98 , p = 0.02 ) and Short Physical Performance Battery scores ( mean change : 2.94 vs. 0.38 , p = 0.02 ) compared with the usual care group . The progressive multicomponent intervention group also had a trend towards significant improvement in the 6-minute walk test at 60 days ( mean change : 119.65 m vs. 19.28 m ; p = 0.07 ) . No adverse events associated with intervention were recorded . Conclusions : The progressive multicomponent intervention  improved patient functional mobility following acute hospitalization more than usual care . Results from this study support the safety and feasibility of conducting a larger r and omized controlled trial of progressive multicomponent intervention in this population . A more definitive study would require 150 patients to verify these conclusions given the effect sizes observed OBJECTIVES The aggregated locomotor function ( ALF ) score , a simple measure of observed locomotor function , using timed walking , stairs and transfers , was developed and evaluated for intra-tester reliability , criterion-related validity and responsiveness in a sample of patients with knee osteoarthritis . METHODS Patients with knee osteoarthritis ( n = 214 ) were recruited for inclusion in a r and omized controlled trial investigating two methods of exercise provision . Before treatment , patients completed the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) and Short Form 36 health survey ( SF-36 ) question naires and were timed whilst performing an 8 m walk , ascending and descending a set of gymnasium stairs and completing a test of transferring in and out of a chair . A group of 15 patients also undertook a replicate test-retest reliability study of the above outcome measures . St and ardized response means were calculated for the ALF , WOMAC and SF-36 from data from the clinical trial . RESULTS The ALF takes 10 min to administer and demonstrated excellent intra-tester reliability , with excellent intra-class correlation coefficient ( ICC ) statistics ( ICC(2,k ) 0.99 ; 95 % CI 0.98 - 0.99 ) , and low st and ard error of measurement ( 0.86 s ) and smallest detectable difference ( 9.5 % ) values . Criterion-related validity with the physical function dimensions of the WOMAC and SF-36 was good , with correlation coefficients of 0.59 and - 0.53 respectively . St and ardized response means were higher for the ALF ( 0.49 ) than for both the WOMAC ( 0.39 ) and the SF-36 ( 0.12 ) . CONCLUSIONS This work has demonstrated that the ALF can be used as a measure of physical function status and as a means of quantifying treatment response . The measure offers a simple and convenient outcome in the assessment and treatment of locomotor dysfunction . The ALF score is a reliable , valid and responsive outcome measure over 12 months and can be recommended for use in the evaluation of patients with knee osteoarthritis PROBLEM STATEMENT Nurses have one of the highest rates of work-related musculoskeletal injury of any profession . Over the past 30 years , efforts to reduce work-related musculoskeletal disorders in nurses have been largely unsuccessful . SPECIFIC AIMS The primary goal of this program was to create safer working environments for nursing staff who provide direct patient care . Our first objective was to design and implement a multifaceted program that successfully integrated evidence -based practice , technology , and safety improvement . The second objective was to evaluate the impact of the program on injury rate , lost and modified work days , job satisfaction , self-reported unsafe patient h and ling acts , level of support for program , staff and patient acceptance , program effectiveness , costs , and return on investment . INTERVENTION The intervention included six program elements : ( 1 ) Ergonomic Assessment Protocol , ( 2 ) Patient H and ling Assessment Criteria and Decision Algorithms , ( 3 ) Peer Leader role , " Back Injury Re source Nurses " , ( 4 ) State-of-the-art Equipment , ( 5 ) After Action Review s , and ( 6 ) No Lift Policy . METHODS A pre-/post design without a control group was used to evaluate the effectiveness of a  patient care ergonomics program  on 23 high risk units ( 19 nursing home care units and 4 spinal cord injury units ) in 7 facilities .  Injury rates , lost work days , modified work days , job satisfaction , staff , and patient acceptance , program effectiveness , and program costs/savings were compared over two nine month periods : pre-intervention ( May 2001-January 2002 ) and post-intervention ( March 2002-November 2002 ) . Data were collected prospect ively through surveys , weekly process logs , injury logs , and cost logs . RESULTS The program elements result ed in a statistically significant decrease in the rate of musculoskeletal injuries as well as the number of modified duty days taken per injury . While the total number of lost workdays decreased by 18 % post-intervention , this difference was not statistically significant . There were statistically significant increases in two subscales of job satisfaction : professional status and tasks requirements . Self-reports by nursing staff revealed a statistically significant decrease in the number of ' unsafe ' patient h and ling practice s performed daily . Nurses ranked program elements they deemed to be " extremely effective " : equipment was rated as most effective ( 96 % ) , followed by No Lift Policy ( 68 % ) , peer leader education program ( 66 % ) , ergonomic assessment protocol ( 59 % ) , patient h and ling assessment criteria and decision algorithms ( 55 % ) , and lastly after action review s ( 41 % ) . Perceived support and interest for the program started at a high level for managers and nursing staff and remained very high throughout the program implementation . Patient acceptance was moderate when the program started but increased to very high by the end of the program . Although the ease and success of program implementation initially varied between and within the facilities , after six months there was strong evidence of support at all levels . The initial capital investment for patient h and ling equipment was recovered in approximately 3.75 years based on annual post-intervention savings of over $ 200,000/year in workers ' compensation expenses and cost savings associated with reduced lost and modified work days and worker compensation . CONCLUSIONS This multi-faceted program result ed in an overall lower injury rate , fewer modified duty days taken per injury , and significant cost savings . The program was well accepted by patients , nursing staff , and administrators . Given the significant increases in two job satisfaction subscales ( professional status and task requirements ) , it is possible that nurse recruitment and retention could be positively impacted OBJECTIVE To examine the value of the  Health Assessment Question naire ( HAQ ) as an outcome measure in short term exercise trials . We studied the association of the objectives of exercise , namely joint mobility , muscle strength , and physical condition , with the HAQ . METHODS Data for 100 patients with rheumatoid arthritis ( RA ) included in a study to examine the effect of exercise therapy were used for secondary analysis . Disease activity was determined by the disease activity score ( DAS3 ) , pain was scored on a visual analog scale ( VAS ) , and depression was measured by the Dutch Arthritis Impact Measurement Scale . Aerobic capacity ( VO2max ) estimated from a submaximal ergometer test , grip strength ( kPa ) ,  isokinetic muscle strength of the knee  ( Nm/kg ) , and the  Escola Paulista de Medicina range of motion ( EPM-ROM ) score , a measure of general flexibility , were used as indicators for physical impairments . All variables were entered in a forward multiple regression analysis with the HAQ as dependent variable . RESULTS The HAQ was significantly correlated with the DAS3 score ( r = 0.53 ) , pain ( r = 0.51 ) , depression ( r = 0.40 ) , joint mobility ( r = 0.27 ) , quadriceps strength ( r = -0.35 ) , and grip strength ( r = -0.50 ) , but not with physical condition . The DAS3 score was first entered in the multiple regression analysis model , followed by pain , quadriceps strength , and grip strength ( R2 = 0.45 ) . After 12 weeks of exercise therapy changes in the HAQ were significantly correlated with changes in pain ( r = 0.41 ) , in depression ( r = 0.33 ) , and in quadriceps strength ( r = -0.25 ) , but not with changes in joint mobility or physical condition . CONCLUSION Physical impairments are weakly associated with the HAQ .  The HAQ is not an appropriate instrument to detect changes in physical impairments due to short term exercise therapy BACKGROUND AND PURPOSE Few r and omized controlled studies have examined the effects of exercise in patients with ankylosing spondylitis ( AS ) . This study investigated the effects of a 12-week , multimodal exercise program in patients with AS . SUBJECTS A convenience sample of 30 patients with AS ( 18 male , 12 female ) , with a mean age of 34.9 years ( SD=6.28 ) , participated in the study . Twenty-six subjects were classified as having stage I AS and 4 subjects were classified as having stage II AS according to the modified New York Criteria . METHODS This study was a r and omized controlled trial . Subjects were assigned to either a group that received an exercise program or to a control group . The exercise program consisted of 50 minutes of multimodal exercise , including aerobic , stretching , and pulmonary exercises , 3 times a week for 3 months . Subjects in both groups received medical treatment for AS , but the exercise group received the exercise program in addition to the medical treatment . All subjects received a physical examination at baseline and at 12 weeks . The examinations were conducted under the supervision of a physician who specialized in physical medicine and rehabilitation and included the assessment of spinal mobility using 2 methods : clinical measurements ( chin-to-chest distance , Modified Schober Flexion Test , occiput-to-wall distance , finger-to-floor distance , and chest expansion ) and inclinometer measurements ( gross hip flexion , gross lumbar flexion , and gross thoracic flexion ) . In addition , vital capacity was measured by a physiologist , and physical work capacity was evaluated by a doctorally prepared exercise instructor . RESULTS The measurements of the exercise group for chest expansion , chin-to-chest distance , Modified Schober Flexion Test , and occiput-to-wall distance were significantly better than those of the control group after the 3-month exercise period . The spinal movements of the exercise group improved significantly at the end of exercise program , but those of the control group showed no significant change . In addition , the results showed that the posttraining value of gross thoracic flexion of the exercise group was significantly higher than that of the control group . Physical work capacity and vital capacity values improved in the exercise group but decreased in the control group . DISCUSSION AND CONCLUSION In this study , a multimodal exercise program including aerobic , stretching , and pulmonary exercises provided in conjunction with routine medical management yielded greater improvements in spinal mobility , work capacity , and chest expansion & NA ; Physical therapists seeking to use evidence to guide their practice may have limited time to read research reports . One way to reduce the time required to identify and read about the research that is relevant to a particular clinical question is to read a systematic review that summarizes multiple studies . This paper explains the process that is used to conduct systematic review s , which includes the establishment of a protocol , comprehensive search ing , appraisal of the quality of the included studies , data extraction and meta analysis , and consideration of the clinical and research implication s of the findings . We also consider how the reader of a systematic review can determine whether the review is likely to provide an unbiased ( believable ) estimate of the treatment effect . A systematic review of r and omized trials of a  cardiopulmonary physical therapy intervention is used as an example . The issue of appraisal of quality is then discussed further , with a demonstration of how one vali date d tool for quality appraisal ‐‐the PEDro scale‐‐can be used to evaluate a r and omized trial in cardiopulmonary physical therapy Abstract Aims : Prospect i ve measures of high knee abduction moment ( KAM ) during l and ing identify female athletes at increased risk for anterior cruciate ligament ( ACL ) injury . Laboratory-driven measurements predict high KAM with 90 % accuracy . This study aim ed to vali date the clinic-based variables against 3-dimensional motion analysis measurements . Methods : Twenty female basketball , soccer , and volleyball players ( age , 15.9 ± 1.3 years ; height , 163.6 ± 9.9 cm ; body mass , 57.0 ± 12.1 kg ) were tested using 3-dimensional motion analysis and clinic-based techniques simultaneously . Multiple logistic regression models have been developed to predict high KAM ( a surrogate for ACL injury risk ) using both measurement techniques . Clinic-based measurements were vali date d against 3-dimensional motion analysis measures , which were recorded simultaneously , using within- and between- method reliability as well as sensitivity and specificity comparisons . Results : The within-variable analysis showed excellent inter-rater reliability for all variables using both 3-dimensional motion analysis and clinic-based methods , with intraclass correlation coefficients ( ICCs ) that ranged from moderate to high ( 0.60 - 0.97 ) . In addition , moderate-to-high agreement was observed between 3-dimensional motion analysis and clinic-based measures , with ICCs ranging from 0.66 to 0.99 . Bl and -Altman plots confirmed that each variable provided no systematic shift between 3-dimensional motion analysis and clinic-based methods , and there was no association between difference and average . A developed regression equation also supported model validity with > 75 % prediction accuracy of high KAM using both the 3-dimensional motion analysis and clinic-based techniques . Conclusion : The current validation provides the critical next step to merge the gap between laboratory identification of injury risk factors and clinical practice . Implementation of the developed prediction tool to identify female athletes with high KAM may facilitate the entry of female athletes with high ACL injury risk into appropriate injury-prevention programs Objective : Evaluation of the effect of the train-the-trainer programme ‘ Fit for Shared Decision-Making ’ on internal ( team ) and external ( patient ) participation in medical rehabilitation from a patient and staff perspective . Design : A multicentre , cluster-r and omized controlled study . Setting : Eleven medical rehabilitation clinics , divided into intervention and control groups . Subjects : A staff and a patient survey were conducted pre- and post-intervention , plus a further patient survey six months later . Intervention : Train-the-trainer programme ‘ Fit for Shared Decision-Making ’ for interprofessional setting s. Main measures : Each survey measured internal participation with a self-compiled six-item scale ( Internal Participation Scale , IPS ) , and external participation by means of a nine-item Shared Decision-Making Question naire ( SDM-Q-9 ) for the patients and for healthcare professionals . Results : Patient sample s numbered 402 for the pre- , 463 for the post-intervention data collection period and 461 six months after the intervention . Patients ’ appraisal of external participation ( Fperiod x group ( 2 ) = 0.256 , p=0.774 , η2=0.000 ) showed no change , whereas internal participation ( Fperiod x group ( 2 ) = 3.785 , p=0.023 , η2=0.007 ) showed a significant increase . A total of 195 healthcare professionals participated in the pre- and 168 in the post-intervention staff survey . Here external participation was significantly enhanced in the intervention group ( Fperiod x group ( 1 ) = 4.893 , p=0.028 , η2=0.014 ) . Conclusions : The train-the-trainer approach can be recommended for implementing internal and external participation in interprofessional setting s such as medical rehabilitation clinics . However , there is a need for more intensive staff training for internal participation and an additional intervention for patients to achieve success in all aspects Principles of motor control and learning such as bilateral coordination and task-specificity , are increasingly incorporated in the design of upper extremity rehabilitation protocol s for stroke survivors . Yet most studies investigating the efficacy of new protocol s report composite scores of st and ardized tests , such as the Fugl-Meyer Upper Extremity test ( FM ) and the Wolf Motor Arm Test , rather than determining how the motor control and coordination of arm movements has changed . Here we present a sub- study of a larger r and omized controlled trial comparing a bilateral and unilateral training protocol where participants were assessed on bilateral and unilateral arm reaching . Eligible participants for the arm reaching analysis were 9 ( FM=37 ) and 9 ( FM=34 ) in Bilateral Arm Training with Rhythmic Auditory Cueing ( BATRAC ) and Dose Matched Therapeutic Exercises ( DMTE ) , respectively . Participants undertook 18 sessions of training for 6 weeks with 20min of active training per session . For bilateral arm reaching , participants after BATRAC were faster , with increased peak acceleration , fewer movement units , and smoother h and paths for each arm . The BATRAC training group showed greater improvements with training than the DMTE group during bilateral reaching for parameters of movement units and smoothness of h and path . For unilateral arm reaching , participants were faster after DMTE for paretic arm reaching ; however , this group did not improve to a greater extent than the BATRAC training group . Within group functional gains were seen after BATRAC on FM , Wolf Motor Arm Test ( time and weight ) and after DMTE on FM and Wolf Weight . There was a positive correlation between movement units and the time component of the Wolf Motor Arm Test . The reaching analysis demonstrates task-specificity in training since BATRAC improves performance in bilateral reaching and DMTE improves performance in unilateral reaching . Temporal/spatial control outcomes in studies of post-stroke interventions can identify functionally relevant motor control changes that are not captured by traditional st and ardized tests
On appraisal , the MCS , M4-MS , and SIMS seem to provide the most practical value for assessing movement quality as they provide the strongest reports of developmental rigor and an identifiable evidence base .
In addition , considering the evidence provided , these tools may have the strongest potential for identifying performance capabilities and guiding exercise prescription in athletic and sport-specific population
Abstract Bennett , H , Davison , K , Arnold , J , Slattery , F , Martin , M , and Norton , K. Multicomponent musculoskeletal movement assessment tools : a systematic review and critical appraisal of their development and applicability to professional practice .
J Strength Cond Res 31(10 ) : 2903–2919 , 2017—Multicomponent movement assessment tools have become commonplace to measure movement quality , proposing to indicate injury risk and performance capabilities .
Despite popular use , there has been no attempt to compare the components of each tool reported in the literature , the processes in which they were developed , or the underpinning rationale for their included content .
As such , the objective of this systematic review was to provide a comprehensive summary of current movement assessment tools and appraise the evidence supporting their development .