Functional Performance In Individuals Research Articles

The immediate effects of foot orthoses on functional performance in individuals with patellofemoral pain syndrome

ObjectivePatellofemoral pain syndrome (PFPS) often results in reduced functional performance. There is growing evidence for the use of foot orthoses to treat this multifactorial condition. In this study, the immediate...

The Immediate Effects Of Foot Orthoses On Functional Performance In Individuals With Patellofemoral Pain Syndrome

Symptoms due to patellofemoral pain syndrome (PFPS) often result in recurrent or chronic knee pain and significantly affect functional performance. Although there is some evidence supporting the use of foot orthoses to treat this multifactorial condition, the effects of foot orthoses on functional performance is unclear. PURPOSE: Evaluate the immediate effects of foot orthoses on functional performance, and the association of foot posture and footwear with improved function. METHODS: A cohort of 52 individuals with PFPS (18 - 35 years) was recruited. Each participant was prescribed standard prefabricated foot orthoses (Vasyli Pro, Vasyli International) to wear in their own footwear. Four functional outcome measures were evaluated including the change in pain and ease of a single leg squat on a 5-point Likert scale using Wilcoxin sign rank statistics, and change in the number of pain free step down and single leg rises from sitting using independent t-tests. The association of foot posture using the Foot Posture Index, normalised navicular drop, and calcaneal angle relative to subtalar joint neutral, and the footwear motion control properties scale score with improved function was evaluated using Spearman's rho statistics. RESULTS The majority (between 71 and 83%) of participants demonstrated reduced functional performance for each of the tests evaluated. Prefabricated foot orthoses produced significant improvements (p <.05) for all functional outcome measures. A more pronated foot type was found to be associated with reduced pain and improved ease of completing a single leg squat, and improvements in the number of pain free single leg rises from sitting after foot orthoses prescription (p <.05). Additionally, poorer motion control properties of participant's footwear were found to be associated with reduced pain during the single leg squat and improvements in the number of pain free single leg rises from sitting after foot orthoses prescription (p <.05). CONCLUSION: Prefabricated foot orthoses are able provide immediate improvements to functional performance in individuals with PFPS. Improved functional performance with foot orthoses is associated with a more pronated foot type and poorer footwear motion control properties.

The Effect of Quality of Movement on the Single Hop Test in Soccer Players Aged 15-16 Years

Sports injuries are one of the most common injuries in modern society. The anterior cruciate ligament (ACL) is commonly injured in sports. Soccer is one of many sports where an ACL injury is likely to occur, due to inherent jumping and pivoting during participation. Abnormal movement patterns have been suggested as a risk factor for knee injuries, which lead to the development of the step-down test. The Single Leg Hop for Distance test is used to assess functional performance in individuals with an ACL injury or reconstruction. The purpose of the current study was to determine if there are differences in hop test distances according to scores on the step-down test. A second purpose is to determine the relationship between hop test distances and height. Sixty-one males and sixty-one females between 15 and 16 years who participated in a club soccer program participated in the study. The Hop test and the step-down test were administered to the subjects. Mean hop distance for males was 172.89 cm (SD = 18.27) and the mean hop distance for females was 146.88 cm (SD = 14.63). For both males and females, there were no differences in hop distances between the left and right lower extremity (LE). There were no differences in hop distances according to classification of the step-down test for males. Females classified as good by the step-down test hopped farther than females classified as poor. There were no relationships between distances in the hop test and height in females (r = .23 for the left LE; .21 for the right LE). There was a low relationship between distances in the hop test and height in males (r = .46 for the left LE; .39 for the right LE). Clinicians may utilize this information for goal setting and objective testing during rehabilitation.

Análise da performance funcional em indivíduos com instabilidade do tornozelo: uma revisão sistemática da literatura

INTRODUÇÃO E OBJETIVO: Os entorses do tornozelo estão entre as lesões mais frequentes nos esportes, nas atividades de vida diária, nos acidentes e nos departamentos de emergências médicas, afetando principalmente os indivíduos jovens fisicamente ativos. O objetivo deste trabalho foi realizar uma revisão sistemática da literatura a fim de levantar a existência de medidas clínicas que avaliem a performance funcional de indivíduos com instabilidade crônica do tornozelo, assim como a de estudos que verifiquem objetivamente a presença de déficits de performance funcional nesses indivíduos. MÉTODO: Foi conduzida uma busca nas bases de dados Medline, Embase e Lilacs. Essa revisão incluiu estudos que descrevem instrumentos de avaliação da performance funcional em indivíduos com instabilidade crônica do tornozelo. Os dois revisores realizaram buscas nas bases de dados computadorizadas de forma independente. RESULTADOS: No total, seis estudos foram incluídos, apenas três considerados de alta qualidade. Os testes descritos na literatura para avaliação de performance funcional em indivíduos com instabilidade do tornozelo foram Cocontraction test, Shuttle run test, Agility hop test, Triple-crossover hop for distance, 6-m shuttle run, Figure-of-8-hop, Side hop, Up-down-hop, Single hop, Multiple hop test e Star excursion balance test. Apenas os dois últimos testes foram capazes de detectar déficits de performance funcional em indivíduos com instabilidade de tornozelo. CONCLUSÃO: Observou-se que, até o momento, apenas os testes Multiple hop test e SEBT têm sua validade e confiabilidade atestadas como ferramentas capazes de detectar déficits de performance funcional em indivíduos com instabilidade do tornozelo.

Self-Assessed Disability and Functional Performance in Individuals With and Without Ankle Instability: A Case Control Study

Single-blind case-control study. To compare functional performance and self-assessed disability scores among individuals with and without chronic ankle instability (CAI) and uninjured controls. After an acute lateral ankle sprain, CAI develops in 40% to 75% of all individuals. However, some individuals, copers, maintain high-level activities after an ankle sprain and do not develop CAI. Studying differences between copers and those with CAI is the first step in developing a clinical battery of tests that can accurately determine which individuals are more likely to develop CAI after an acute lateral ankle sprain. Participants were 24 active adults with unilateral CAI (mean +/- SD age, 21.7 +/- 2.8 years), 24 copers (20.8 +/- 1.5 years), and 24 uninjured controls (21.8 +/- 2.6 years). Participants completed 3 questionnaires of self-assessed disability: (1) Foot and Ankle Disability Index, (2) Foot and Ankle Disability Index-Sport, and (3) a questionnaire of ankle function. Four hop tests were also completed: (1) figure-8 hop, (2) side-to-side hop, (3) triple-crossover hop, and (4) single-leg hop for distance. Self-assessed disability was significantly different among groups (P<.001), but hop test scores (P = .259) were not. Those with CAI had greater self-assessed disability than copers and uninjured controls. Copers and uninjured controls did not differ in self-assessed disability or functional performance. Self-assessed disability is significantly greater in those with CAI than copersand uninjured controls. However, functional performance, measured by hop tests, did not differ among groups.

Test-Retest Reliability and Cross Validation of the Functioning Everyday With a Wheelchair Instrument

The purpose of this study was to establish the test-retest reliability and content validity of an outcomes tool designed to measure the effectiveness of seating-mobility interventions on the functional performance of individuals who use wheelchairs or scooters as their primary seating-mobility device. The instrument, Functioning Everyday With a Wheelchair (FEW), is a questionnaire designed to measure perceived user function related to wheelchair/scooter use. Using consumer-generated items, FEW Beta Version 1.0 was developed and test-retest reliability was established. Cross-validation of FEW Beta Version 1.0 was then carried out with five samples of seating-mobility users to establish content validity. Based on the content validity study, FEW Version 2.0 was developed and administered to seating-mobility consumers to examine its test-retest reliability. FEW Beta Version 1.0 yielded an intraclass correlation coefficient (ICC) Model (3,k) of .92, p < .001, and the content validity results revealed that FEW Beta Version 1.0 captured 55% of seating-mobility goals reported by consumers across five samples. FEW Version 2.0 yielded ICC(3,k) = .86, p < .001, and captured 98.5% of consumers' seating-mobility goals. The cross-validation study identified new categories of seating-mobility goals for inclusion in FEW Version 2.0, and the content validity of FEW Version 2.0 was confirmed. FEW Beta Version 1.0 and FEW Version 2.0 were highly stable in their measurement of participants' seating-mobility goals over a 1-week interval.

Task-oriented progressive resistance strength training improves muscle strength and functional performance in individuals with stroke

Objective: To examine the effectiveness of task-oriented progressive resistance strength training on lower extremity strength and functional performance in chronic stroke subjects. Design: Single-blind, randomized controlled trial. Setting: Medical centre and district hospital. Subjects: Forty-eight subjects at least one year post stroke. Interventions: Participants randomly allocated to two groups, control (n-/24) and experimental (n-/24). Subjects in the control group did not receive any rehabilitation training. Subjects in the experimental group were put on a four-week task-oriented progressive resistance strength training. Main measures: Lower extremity muscle strength, gait velocity, cadence, stride length, six-minute walk test, step test, and timed up and go test. Results: Muscle strength significantly improved in the experimental group for strong side muscle groups (ranged from 23.9% to 36.5%) and paretic side muscle groups (ranged from 10.1% to 77.9%). In the control group muscle strength changes ranged from 6.7% gain to 11.2% decline. The experimental group showed significant improvement in all selected measures of functional performance except for the step test. In the control group, the number of repetitions of the step test significantly decreased (-20.3%) with no change in other functional tests. There was a significant difference between groups for muscle strength and all functional measures. The strength gain was significantly associated with gain in the functional tests. Conclusions: The task-oriented progressive resistance strength training programme could improve lower extremity muscle strength in individuals with chronic stroke and could carry over into improvement in functional abilities.

The Effect of Ginkgo Biloba on Functional Measures in Multiple Sclerosis: A Pilot Randomized Controlled Trial

Multiple sclerosis (MS) is a chronic demyelinating neurological disease afflicting young and middle-aged adults, resulting in problems with coordination, strength, cognition, affect, and sensation. The objective of this study was to determine whether a ginkgo extract (EGb 761) improved functional performance in individuals with MS. This study used a double-blind, placebo-controlled, parallel group design. The end point was change between baseline (ie, preintervention) and follow-up evaluation following a regimen of four tablets per day at 60 mg per tablet for four weeks. The study was conducted in academic and clinical-based settings. Twenty-two individuals with MS were randomly assigned to either the treatment or control condition. Groups did not differ with respect to age, IQ, and education. Half of the subjects received 240 mg per day of ginkgo special extract (EGb 761), and the other half received placebo. The main outcome measures assessed depression (Center for Epidemiologic Studies of Depression Scale [CES-D]), anxiety (State-Trait Anxiety Inventory [STAI]), fatigue (Modified Fatigue Impact Scale [MFIS]); symptom severity (Symptom Inventory [SI]) and functional performance (Functional Assessment of Multiple Sclerosis [FAMS]). The ginkgo group had significantly more individuals showing improvement on four or more measures with improvements associated with significantly larger effect sizes on measures of fatigue, symptom severity, and functionality. The ginkgo group also exhibited less fatigue at follow-up compared with the placebo group. This exploratory pilot study showed that no adverse events or side effects were reported and that ginkgo exerted modest beneficial effects on select functional measures (eg, fatigue) among some individuals with MS.

ACETYLATED FATTY ACID TOPICAL CREAM WITH MENTHOL REDUCES PAIN AND IMPROVES FUNCTIONAL PERFORMANCE IN INDIVIDUALS WITH ARTHRITIS

This investigation was an extension of a previous study conducted in our laboratory in which we showed that 1 month of treatment with a topical cream (Celadrint) consisting of cetylated fatty acids was effective for reducing pain and improving functional performance in individuals with osteoarthritis (OA) of the knee (Kraemer et al., Journal of Rheumatology, 2004). We wanted to verify that the addition of menthol to the compound would produce a similar percentage of improvement in therapeutic effects. We used a single treatment group with a pre-post experimental design to examine % treatment changes. Individuals diagnosed with OA of the knee (N = 10; age, 66.4 ± 11.5 years) and severe pain (e.g., OA, rheumatoid arthritis) of the elbow (N = 8; age, 59.1 ± 18.2 years) and wrist (N = 10; age, 60.3 ± 16.8 years) were tested for pain and functional performance before and after 1 week of treatment with a topical cream consisting of cetylated fatty acids and menthol applied twice per day. In individuals with knee OA, significant improvements in stair-climbing ability (about 12%), “up-and-go‘” performance (about 12%), balance and strength (about 16.5%), and range of motion (about 3.5%) were observed, as were reductions in pain. In individuals with severe pain of the elbow and wrist, significant improvements in dynamic (about 22 and 24.5%, respectively) and isometric (about 33 and 42%, respectively) local muscular endurance were observed, as was a reduction in pain. Neither group demonstrated significant changes in maximal grip strength or maximal force production. One week of treatment with a topical cream consisting of cetylated fatty acids and menthol was similarly effective for reducing pain and improving functional performance in individuals with arthritis of the knee, elbow, and wrist. The % changes were consistent with our prior work on the compound without menthol. Further work is needed to determine the impact of menthol in such a cream. Nevertheless, our data support the use of a topical cream consisting of cetylated fatty acids (with or without menthol) for enhancing the potential for exercise training in this population.

Electrical Stimulation-assisted Cycling Training In Patients With Stroke

To counteract the reduction in functional capacity and the deconditioning that commonly occur after stroke, therapies such as walking and upright cycling are often applied. However, balance problems frequently reduce the efficacy of therapy. In addition, the paralyzed muscle fibers are not trained, which leads to severe atrophy of these fibers. Voluntary leg cycling exercise (LCE) on a semi-recumbent ergometer with additional application of electrical stimulation (ES) might overcome both these problems. PURPOSE To determine if LCE training improves functional performance and endurance capacity in patients with stroke and to evaluate if the application of ES to the paretic leg has additional effects. METHODS 8 subjects (4 men; 55±10 yrs) with chronic (16±7 months) stroke performed 12 30-min sessions (2/wk) of LCE (Ergys 2, Therapeutic Alliances), while resistance was increased with improvements in performance. Five subjects (EXP) received maximally tolerable ES and 3 subjects (CON) received just sensible ES that could not evoke contractions during their exercise on the bicycle. Computer-controlled ES was applied through surface electrodes to the quadriceps, hamstrings and gluteals of the paretic leg. Before and after training, a voluntary (no ES) progressive exercise cycling test elicited maximal power output (POmax) and Vo2max. Functional performance was assessed by a 6-min walking test (D6min), the Berg Balance Scale (BBS), and the Rivermead Mobility Index (RMI). RESULTS For the whole group, significant (p<0.05) improvements were found for POmax (47±14 to 64±20 W; +39%), BBS (43±9 to 46±8; +6%), RMI (11.6±2.3 to 12.5 ±1.3; +6%), D6min (168±118 to 183±120 m; +13%), and a tendency towards an improved Vo2max (0.97±0.26 to 1.08± 0.27 L·min−1; +14%). Compared to CON, the EXP group tended to have larger improvements in Vo2max (15.4 vs 5.7%), D6min (11.1 vs 6.4%), BBS (9.9 vs 4.0%), and RMI (9.1 vs 5.2%), but no significant differences were detected. CONCLUSIONS This study shows that a 6-wk LCE training program on a semi-recumbent cycle ergometer can markedly improve endurance capacity and functional performance in individuals with chronic stroke. The use of ES to the paretic leg may result in additional improvements, but more research is warranted to establish this.

A Cetylated Fatty Acid Topical Cream With Menthol Reduces Pain and Improves Functional Performance in Individuals With Arthritis

This investigation was an extension of a previous study conducted in our laboratory in which we showed that 1 month of treatment with a topical cream (Celadrin) consisting of cetylated fatty acids was effective for reducing pain and improving functional performance in individuals with osteoarthritis (OA) of the knee (Kraemer et al., Journal of Rheumatology, 2004). We wanted to verify that the addition of menthol to the compound would produce a similar percentage of improvement in therapeutic effects. We used a single treatment group with a pre-post experimental design to examine % treatment changes. Individuals diagnosed with OA of the knee (N = 10; age, 66.4 +/- 11.5 years) and severe pain (e.g., OA, rheumatoid arthritis) of the elbow (N = 8; age, 59.1 +/- 18.2 years) and wrist (N = 10; age, 60.3 +/- 16.8 years) were tested for pain and functional performance before and after 1 week of treatment with a topical cream consisting of cetylated fatty acids and menthol applied twice per day. In individuals with knee OA, significant improvements in stair-climbing ability (about 12%), "up-and-go" performance (about 12%), balance and strength (about 16.5%), and range of motion (about 3.5%) were observed, as were reductions in pain. In individuals with severe pain of the elbow and wrist, significant improvements in dynamic (about 22 and 24.5%, respectively) and isometric (about 33 and 42%, respectively) local muscular endurance were observed, as was a reduction in pain. Neither group demonstrated significant changes in maximal grip strength or maximal force production. One week of treatment with a topical cream consisting of cetylated fatty acids and menthol was similarly effective for reducing pain and improving functional performance in individuals with arthritis of the knee, elbow, and wrist. The % changes were consistent with our prior work on the compound without menthol. Further work is needed to determine the impact of menthol in such a cream. Nevertheless, our data support the use of a topical cream consisting of cetylated fatty acids (with or without menthol) for enhancing the potential for exercise training in this population.

Significance of behavioral pathology on functional performance in individuals with Alzheimer's disease and related dementias.

Insight on the role of frontal systems functioning has led to the development of measures targeting behaviors mediated through the prefrontal cortex. The current review investigated the relationship of behavioral pathology to functional performance in individuals with dementia and discussed the association of behavioral pathology and executive dysfunction. Results indicated that both behavioral measures and cognitive status were strongly correlated to functional performance. However, neither behavioral measure nor cognitive status demonstrated a stronger association to functional performance at a greater consistency than the other measure. This review has important implications for the use of behavior measures by medical practitioners to determine the functional status of persons with Alzheimer's disease (AD) and other dementias and the use of results obtained by these measures to develop appropriate intervention strategies.

Environmental effects on the assessment of people with dementia: a pilot study.

The purpose of this pilot study was to use a standardized assessment of independent living skills to explore the effects of environment on functional performance of individuals with dementia. Twelve participants (6 males, 6 females), diagnosed with dementia, were given the Structured Assessment of Independent Living Skills (SAILS), a standardized assessment of functional motor, cognitive, instrumental, and social performance. Participants were assessed in their homes, in an adult day-services facility they regularly attended, and in an occupational therapy clinic. Data were analyzed using repeated measures analysis of variance (ANOVA). There was no evidence of a learning effect from repeated assessments. Participants' performances did not differ among the home, clinic, and adult day-services settings on the total SAILS score (F = 1.22; df = 2,20; p = 0.3176), nor on three of its subscales: cognitive score (F = 0.80; df = 2,20; p = 0.4648), instrumental activities (F = 1.37; df = 2,20; p = 0.2777), and social interaction (F = 0.34; df = 2,20; p = 0.7147). However, participants' performance on the SAILS motor score was significantly higher in the home than in the clinic (t = 2.925, df = 11, p = 0.0138). CONCLUSION. Participants' motor performance was significantly better at home than in an unfamiliar environment. Effects of environment on motor performance, and absence of effects on cognitive, instrumental, and social performances, can be explained through ecological theory. These results suggest that the ability to adapt movement to an unfamiliar environment may decline with the onset and progression of dementia.

OTFACT: Multi-level performance-oriented software with an assistive technology outcomes assessment protocol

OTFACT is a software-based data collection system that implements several unique strategies for measuring assistive technology outcomes. The software uses adaptive questioning to focus on the particular needs of the individual. The computer also creates an efficient data collection platform that makes it practical to use a longer question set to optimise reliability. A functional outcomes theory grounds OTFACT, producing a multi-level question domain similar to the WHO and other global taxonomies. Studies of the reliability and validity of OTFACT have extended beyond the instrument itself to address scaling issues created by the dynamic implementation of questions. Among its scaling features, OTFACT uses a 0-100 percent function scale that normalizes individual scores to a standard criterion-based range. OTFACT includes a feature for comparing the differential functional performance of individuals when they use AT.

Improved physical performance after orthotopic liver transplantation.

Orthotopic liver transplantation (OLT) has become a frequently used treatment for end-stage liver disease and acute liver failure, and liver function is markedly improved after transplantation. However, no studies have investigated the development in physical capacity after OLT. On this basis, the aim of the present study is to study the influence of OLT on physical fitness during the first postoperative year. Twenty-three men with a mean age of 45.1 years (range, 24 to 62 years) and 15 women with a mean age of 44.6 years (range, 21 to 62 years) were included in the study. Preoperative maximal oxygen uptake (VO2max) during graded ergometer bicycling, isokinetic knee extension/flexion moments, and functional performance (i.e., 6-minute walking distance and standardized transfers and squats) was measured. Preoperative fitness and strength was 40% to 50% less than expected in the age-matched general population. Post-OLT, all patients underwent a supervised exercise program for 8 to 24 weeks. Follow-up data showed a significant increase in all tested physical performance parameters after OLT. Six months post-OLT, VO2max had increased 43%; knee strength, 60% to 100%; and functional performance, 22% to 27%. One year postsurgery, general health was improved and perceived as excellent or good in all patients. All patients were independent in activities of daily living, and the level of physical activity increased after OLT. No further improvement in either physical performance parameters or self-assessed parameters was seen beyond 6 months after OLT. In conclusion, these findings indicate that OLT combined with a supervised post-OLT exercise program improves physical fitness, muscle strength, and functional performance in individuals with chronic liver disease.