Repeated Measures Experimental Study Research Articles

Abstract P141: Six-Month Follow-Up of Menopausia, Salud, Corazón (Menopause, Health, Heart): A Multi-Component Intervention to Reduce Cardiovascular Disease Risk in Midlife Latinas

Background: Cardiovascular disease (CVD) risk increases substantially during perimenopause. Latinas have a significantly worse CVD risk factor profile than non-Latina White women, potentially due to multiple sociocultural and environmental factors. The purpose of this study is to evaluate the feasibility and initial efficacy of a multi-component intervention to reduce CVD risk in perimenopausal Latinas. Here we report data at a 6-month follow-up. Methods: This is a randomized two-group, repeated measures experimental study. Forty-nine perimenopausal Latinas (age 40-60 years) were randomized to a 6-month multi-component intervention or wait-list control. The intervention consists of 12-weekly culturally tailored Spanish language-based sessions (education, physical activity, stress management, coping skills training), followed by 3 months of continued support, and 6 months of skill maintenance on their own. Between May 2021 and June 2022, thirty-five participants (18 intervention and 17 control) completed a 6-month follow-up. Primary outcomes at this study visit included weight, body mass index, waist circumference, and blood pressure. Secondary outcomes included health behaviors and psychological factors (nutrition, physical activity, sleep, self-efficacy, perceived stress). We assessed the initial efficacy of the intervention at 6 months using general linear models for continuous outcomes and logistic regression for categorical outcomes. Models adjusted for outcome measures at baseline and baseline group differences (health insurance, vasomotor symptoms). Models were two-sided at a level of significance of p≤0.1. Results: At baseline, the mean age was 47.8 ± 4.4 years, 37% had less than high school education, 97% were born outside of the United States, and 51% reported it was somewhat/very difficult to pay for basics. Women in the intervention group were more likely to have health insurance (61% vs 24%, p=0.06) and less likely to report any vasomotor symptoms (44% vs 77%, p=0.09). At 6 months (post-intervention), compared to the waitlist control group, the intervention group had lower perceived stress (ß[SE]= -2.15 [1.05], p=0.05) and systolic blood pressure (ß[SE]= -2.72 [1.61], p=0.1) even after adjusting for baseline measures and group differences. There were no other significant differences post-intervention. Conclusions: This pilot study found that a culturally tailored Spanish language intervention consisting of nutrition education, physical activity, and stress management may be effective in reducing stress and blood pressure in perimenopausal Latinas —key risk factors for CVD.

Advancing our understanding and assessment of cognitive effort in the cognitive fit theory and data visualization context: Eye tracking-based approach

In Cognitive Fit Theory (CFT) based research, there is a consensus about cognitive effort as the underlying mechanism impacting performance. Although critical to the theory, cognitive effort and its direct empirical assessment remain a challenge. In this repeated measures experimental study, we introduce a research model and develop hypotheses based on the fundamental relationships underlying CFT while integrating eye tracking as an approach for assessing cognitive effort. Our study finds that eye tracking technology, specifically fixation-based metrics, can be used in the understanding of cognitive processes initiated by our data representation choices. Specifically, we find that in all tasks except the complex-symbolic task, users experience meaningful change in the physiological assessment of cognitive effort based on the condition of cognitive fit. We contrast our findings to existing research and find that physiological indicators of cognitive effort can provide critical insights often missed in traditional CFT research.

Abstract 12171: Recruitment and Enrollment of Midlife Latinas in a Multi-Component Intervention to Reduce Cardiovascular Disease Risk: Challenges and Innovations During COVID-19

Introduction: Latinos continue to be underrepresented in clinical research. The novel coronavirus (COVID-19) pandemic has presented additional challenges to conducting clinical research among Latino communities. Menopausia, Salud y Corazón is a two-group pilot intervention designed to reduce cardiovascular disease (CVD) risk in Latinas during the menopause transition. The purpose of this report is to summarize the innovative recruitment methods developed in response to COVID-19, which may enhance future clinical research with Latinas. Methods: This is a two-group, repeated measures experimental study. Eligible participants are Latinas age 40-60 years, who are perimenopausal or early postmenopausal, and free of CVD. In response to COVID-19, the recruitment and enrollment protocol was adjusted to include: remote modalities of recruitment, limited in-person visits, and adhering to COVID-19 safety guidelines (i.e., social distancing, personal protective equipment, sanitizing, temperature and symptom checklists). We recruited at drive-thru health fairs, churches, social media, and word of mouth. A bilingual research team was able to establish rapport and build relations. We developed communication strategies via mailings, infographics, phone calls, video conferencing and text messages that addressed Latino cultural values such as respeto (respect), familismo (loyalty to family), and confianza (trust). Results: After 8 months of recruitment, 79 women were screened for eligibility, with mean age 47.9 ± 5.2 years. All participants completed screening in Spanish and 16.4% (n=13) rated their overall health as “very good/excellent.” Twenty-eight (35.4%) participants screened were recruited through word of mouth and 29.1% were recruited through their parish. Of the individuals screened, 38 (48.1%) were eligible. The most common reason for ineligibility was menopause status (n=21, 26.5%) Conclusions: Despite the challenges presented by COVID-19, we found that midlife Latinas are receptive to research engagement. Researcher flexibility, multiple modalities of recruitment, a bilingual research team, and communication strategies that address cultural values are important elements for the representation of Latinas in research.

A multi-component, community-engaged intervention to reduce cardiovascular disease risk in perimenopausal Latinas: pilot study protocol

BackgroundCardiovascular disease (CVD) risk increases substantially during perimenopause. Latinas have a significantly worse CVD risk factor profile than non-Hispanic White women, potentially due to multiple sociocultural and environmental factors. To date, interdisciplinary interventions have not focused on improving nutrition, physical activity, stress management, and biologic CVD risk in perimenopausal Latinas. The purpose of this study is to examine the feasibility and initial efficacy of a multi-component intervention to reduce CVD risk in perimenopausal Latinas.MethodsThis is a two-group, repeated measures experimental study. Eighty perimenopausal Latinas (age 40–55 years) from two community groups will be randomized: one group will complete the intervention; the other will be a wait-list control. The intervention consists of 12-weekly sessions (education, physical activity, stress management, coping skills training), followed by 3 months of continued support, and 6 months of skill maintenance on their own. The primary outcomes include arterial stiffness, blood pressure, lipids, and blood glucose. Secondary outcomes are health behaviors (nutrition, physical activity, sleep, coping strategies), self-efficacy, and other biological factors related to CVD risk (adiposity, C-reactive protein, hair cortisol, vasomotor symptoms). We will assess changes in outcomes from Time 1 (baseline) to Time 2 (6 months) and Time 3 (12 months) using general linear mixed models to test the hypotheses. We will also evaluate the feasibility of the intervention by assessing enrollment and retention rates, barriers, and facilitators to enrollment, intervention fidelity, the suitability of study procedures, and participant satisfaction with the intervention and study protocol. We hypothesize the intervention group will decrease biologic CVD risk and improve health behaviors and self-efficacy significantly more than the wait-list control.DiscussionResults from this study will contribute to knowledge on the feasibility of behavioral interventions, including stress management and coping skills training, which could reduce CVD burden among perimenopausal Latinas. Because Hispanic/Latinos are the largest ethnic minority in the United States (US), progress regarding CVD risk among perimenopausal Latinas may lead to significant improvement in the overall CVD burden in the US.Trial registrationProspectively registered, NCT04313751 (03/19/2020), Protocol version 1.0

The Challenges of Green Marketing Communication: Effective Communication to Environmentally Conscious but Skeptical Consumers

Effectively communicating properties of environmental products to consumers can be challenging. This especially pertains to highly environmentally conscious (HEC)—yet skeptical—consumers, since this target group must balance the need for reliable product knowledge with high sensitivity to often ambiguous nonverbal cues about a product’s environmental friendliness (e.g., environmental pictures). Using a group-specific (2 ×) 2 × 2 repeated-measures experimental study, we investigated the effect of communication-channel-specificity (verbal and nonverbal) to convey the environmental friendliness of products and evaluated consumers’ environmental skepticism and attention during product presentation. Environmental information delivered via a verbal/text-based communication channel translates into low skepticism for both HEC and low environmental consciousness (LEC) consumers. However, nonverbal/pictorial communication proved persuasive only for LEC consumers; HEC consumers exhibited high levels of skepticism, which, in turn, decreased the products’ perceived environmental friendliness. The analysis of combined verbal and nonverbal communication presented here provides a promising framework for effective green marketing communication.

The Impact of Evidence Type on Police Investigators’ Perceptions of Suspect Culpability and Evidence Reliability

Abstract. In a repeated-measures experimental study, we examined how evidence type influences police investigators’ beliefs about (a) suspect’s culpability and (b) reliability of incriminating evidence. South Korean detectives ( N = 202) read four crime reports including general information about a crime and a suspect. In the general case information, one piece of critical and several pieces of noncritical evidence collected during the investigation were presented. Officers read four simulated reports of crimes, and in each report, they were given one piece of evidence linking the suspect to the crime. We manipulated the critical evidence identifying the suspect with four evidence types: CCTV, DNA, fingerprint, and eyewitness testimony. We found that evidence type influenced detectives’ judgments about suspect’s culpability and evidence reliability, such that when eyewitness (vs. CCTV, DNA, fingerprint) evidence was given as critical evidence, officers were more likely to think that the suspect was less culpable and that the evidence was less reliable. Theoretical and legal implications of these results are discussed.

Pain-Induced Alcohol Urge and Intention to Drink: the Role of Dispositional Mindfulness

Experimental findings have shown that pain increased alcohol urge and intention to use alcohol, and that this relation was mediated by pain-induced negative affect. We sought to extend this research by examining (a) whether dispositional mindfulness moderates the indirect effect of experimental pain induction on alcohol use proxies via negative affect and (b) whether the five mindfulness facets, tested independently, differentially moderate the mediation model. Secondary data analysis of a repeated measures experimental study was conducted using moderated mediation analyses. Participants included 61 undergraduate students (Mage = 18.7, SD = 0.82; 50.8% male) who endorsed risky drinking. Results showed that the index of moderated mediation was significant for the mindfulness facets of observing, describing, and non-reactivity. Specifically, pain increased alcohol use proxies via increased negative affect for participants who were either low in non-reactivity or high in the observing or describing mindfulness facets. Conversely, negative affect was less important in the pain-alcohol relation for individuals high in non-reactivity or low in observing or describing mindfulness facets. There were no significant moderating effects of overall mindfulness or the awareness and non-judging facets. The differential relations of mindfulness facets found in this study highlight the need to consider the multifaceted nature of mindfulness when exploring the physical pain and alcohol relation. Further research should confirm whether lower levels of non-reactivity and higher levels of observing or describing may be indicators that an individual suffering from pain-related alcohol use will benefit from pain treatment that targets pain-related negative affect.

Always together or alone first? Effects of type of collaborative translation on Spanish L2 development

ABSTRACTRooted in socio-constructivism, the present article investigates the effects of type of collaborative translation on Spanish L2 development, triangulating data from task performance, learning outcomes, and learners’ perceptions. Thirteen dyads of college students participated in a within-subjects repeated-measures experimental study, translating authentic texts in two ways: collaborating from the get-go and after working alone first. Results showed that while participants translated more lexical items accurately when working together from the get-go, both types of collaborative translation propelled similar learning gains in lexis and grammar. Of the two, only lexical learning was retained after one week. Participants, contrary to results, reported a clear preference for working alone first, which they perceived as more conducive to learning.

The effectiveness of multimedia education for patients with type 2 diabetes mellitus.

The aim of this study was to explore the effectiveness of two types of health education on improving knowledge concerning diabetes and insulin injection, insulin injection skills and self-efficacy, satisfaction with health education and glycated haemoglobin (HbA1c) and creatinine levels among patients with type 2 diabetes who began insulin therapy using a pen injector. Insulin therapy is recommended to facilitate the regulation of plasma glucose; however, patient's acceptance of insulin therapy is generally low. Healthcare providers should help them improve their knowledge of diabetes and insulin injection, as well as their insulin injection skills. A randomized repeated measures experimental study design. The experimental (n=21) and control (n=21) groups received multimedia and regular health education programmes, respectively from October 2013-August 2014. Four structured questionnaires were used and videotapes were applied to demonstrate injection skills. Generalized estimating equations showed that the experimental group's scores were significantly higher than those of the control group for diabetes and insulin injection knowledge, insulin injection skills, self-efficacy in insulin injection and satisfaction with health education. On the other hand, an analysis of covariance revealed glycated hemoglobin (HbA1c) and creatinine levels did not differ significantly between the two groups. Implementation of a multimedia diabetes education programme could improve patients' diabetes and insulin injection knowledge, insulin injection skills, self-efficacy in insulin injection and satisfaction with health education. Healthcare providers should improve quality of patient care by providing multimedia diabetes health education.

Tablet App ASTON halometer for the assessment of dysphotopsia

To assess the validity and repeatability of the Aston Halometer. University clinic, United Kingdom. Prospective, repeated-measures experimental study. The halometer comprises a bright light-emitting-diode (LED) glare source in the center of an iPad4. Letters subtending 0.21° (~0.3 logMAR) were moved centrifugally from the LED in 0.05 degree steps in 8 orientations separated by 45 degrees for each of 4 contrast levels (1000, 500, 100, and 25 Weber contrast units [Cw]) in random order. Bangerter occlusion foils were inserted in front of the right eye to simulate monocular glare conditions in 20 subjects (mean age 27.7 ± 3.1 years). Subjects were positioned 2 meters from the screen in a dark room with the iPad controlled from an iPhone via Bluetooth operated by the researcher. The C-Quant straylight meter was also used with each of the foils to measure the level of straylight over the retina. Halometry and straylight repeatability was assessed at a second visit. Halo size increased with the different occlusion foils and target contrasts (F = 29.564, P < .001) as expected and in a pattern similar to straylight measures (F = 80.655, P < 0.001). Lower contrast letters showed better sensitivity but larger glare-obscured areas, resulting in ceiling effects caused by the screen's field-of-view, with 500 Cw being the best compromise. Intraobserver and interobserver repeatability of the Aston Halometer was good (500Cw: 0.84 to 0.93 and 0.53 to 0.73) and similar to the straylight meter. The halometer provides a sensitive, repeatable way of quantifying a patient-recognized form of disability glare in multiple orientations to add objectivity to subjectively reported discomfort glare.

Swing phase kinematics of horses trotting over poles

Trotting over poles is used therapeutically to restore full ranges of limb joint motion. The mechanics of trotting over poles have not yet been described, hence quantitative evidence for the presumed therapeutic effects is lacking. To compare limb kinematics in horses trotting over level ground, over low poles and over high poles to determine changes in joint angulations and hoof flight arcs. Repeated measures experimental study in sound horses. Standard motion analysis procedures with skin-fixed reflective markers were used to measure swing phase kinematics from 8 horses trotting on level ground, over low (11 cm) and high (20 cm) poles spaced 1.05 ± 0.05 m apart. Spatiotemporal variables and peak swing phase joint flexion angles were compared using repeated measures ANOVA (P<0.05) with Bonferroni correction for pairwise post hoc testing. Peak heights of the fore and hind hooves increased significantly and progressively from no poles (fore: 13.8 ± 3.8 cm; hind: 10.8 ± 2.4 cm) to low poles (fore: 30.9 ± 4.9 cm; hind: 24.9 ± 3.7 cm) and to high poles (fore: 41.0 ± 3.9 cm; hind: 32.7 ± 4.0 cm). All joints of the fore- and hindlimbs contributed to the increase in hoof height through increased swing phase flexion. The hooves cleared the poles due to increases in joint flexion rather than by raising the body higher during the suspension phases of the stride. The increases in swing phase joint flexions indicate that trotting over poles is effective for activating and strengthening the flexor musculature. Unlike the use of proprioceptive stimulation devices in which the effects decrease over time due to habituation, the horse is required to elevate the hooves to ensure clearance whenever poles are present. The need to raise the limbs sufficiently to clear the poles and place the hooves accurately requires visuomotor coordination, which may be useful in the rehabilitation of neurological cases. The Summary is available in Chinese - see Supporting information.

Cuanta más psicología, mejor: eficacia para dejar de fumar de la terapia cognitiva conductual intensiva y de los parches de nicotina combinados con terapia cognitiva conductual intensiva y menos intensiva: Primer premio de la XX edición del Premio de Psicología Aplicada “Rafael Burgaleta” 2013

In order to compare the efficacy of smoking cessation treatment using intensive cognitive-behavioral therapy (I/CBT) versus a combination of I/CBT plus nicotine patches (I/CBT+NP) or a combination of no intensive cognitive-behavioral therapy plus nicotine patches (NI/CBT+NP), a repeated measures experimental study was conducted with 235 adult smokers randomly assigned to one out of three treatments. Among patients who completed treatment (n=152), I/CBT+NP showed higher abstinence rates at 6-month follow-up and one-year follow-up than those showed by NI/CBT+NP, whereas the abstinence rates of I/CBT were not significantly different from those of the other two treatments. Results suggest that nicotine patches should always be used with a cognitive-behavioral therapy as intensive as possible. They also suggest that intensive cognitive-behavioral therapy administered alone should be given greater prominence in clinical guidelines for smoking cessation.

Intra‐Articular Pharmacokinetics of a Gentamicin Impregnated Collagen Sponge in the Canine Stifle: An Experimental Study

To investigate local and systemic pharmacokinetics of gentamicin after intra-articular implantation of a gentamicin impregnated collagen sponge (GICS) in the inflamed canine joint. Descriptive repeated measures experimental study. Dogs (n = 9). Stifle joint inflammation was caused by urate injection. Twenty-four hours later a GICS (gentamicin dose, 6 mg/kg) was arthroscopically implanted. Synovial fluid and plasma gentamicin concentrations were measured for 14 days after implantation, and pharmacokinetic parameters modeled using statistical moment analyses. Intra-articular gentamicin concentrations fell to sub-MIC for Staphylococcus sp. (4 µg/mL) by 22.4 hours (95% CI: 18.6-26.2) after sponge implantation. Cmax synovial was 2397 µg/mL (95%CI: 1161-3634 µg/mL) at 1.2 hours (95%CI: 0.5-1.8 hours). Plasma gentamicin concentrations achieved levels of Cmax plasma = 8.0 µg/mL (95%CI: 6.1-10.0 µg/mL) at 1.5 hours (95%CI: 0.8-2.1) after GICS placement and fell below target trough of 2.0 µg/mL by 5.6 hours (95%CI: 4.7-6.5 hours) after GICS placement. Intra-articular gentamicin concentration after GICS placement at an IV-equivalent dose reached high levels and declined rapidly. The maximum plasma levels attained were ∼1/3 of the recommended sub-toxic target for people after parenteral gentamicin administration.

Isolation of infraspinatus in clinical test positions

Existing clinical tests for infraspinatus lack accuracy and differentiation from supraspinatus is difficult. We aimed to find a position that isolated infraspinatus contraction from supraspinatus and to analyse the contraction characteristics of lower (oblique) and upper (transverse) parts of infraspinatus. Within-participant, repeated measures experimental study. Intramuscular electromyography was used to measure the level of activation (electromyographic amplitude as a percentage of maximal voluntary contraction) of infraspinatus and supraspinatus on 15 healthy participants. Participants produced an isometric external rotation force at the shoulder, against manual resistance in shoulder positions of neutral, flexion, abduction and extension. Longitudinal force along the humeral axis was also applied. The two parts of infraspinatus demonstrated different patterns of electromyographic activation. The oblique part of infraspinatus was "markedly active" in all positions while the transverse part was mostly "moderately active". Comparing supraspinatus with infraspinatus, it was found that infraspinatus was significantly more active than supraspinatus from the positions of shoulder flexion and neutral with the highest ratios observed in the position of shoulder flexion. Longitudinal humeral force was not an important factor. If isometric external rotation of the shoulder is performed against resistance, the oblique part of infraspinatus will be working harder than the transverse part, irrespective of shoulder position. If differentiation of infraspinatus contraction from supraspinatus is desired, external rotation should be performed from a position of shoulder flexion or neutral. Resisted external rotation in shoulder flexion may form the basis of the development of a more accurate clinical test for infraspinatus.

Computer-based intervention to enhance self-management of calcium and vitamin D intake in women.

Despite the growing prevalence of osteoporosis, many middle-age women do not engage in recommended bone health promotion behaviors. Based on the Integrated Theory of Health Behavior Change, an intervention was designed to increase the self-management behaviors of calcium and vitamin D intake by strengthening health beliefs and using self-regulation skills. In this repeated measures experimental study, a convenience sample of 148 healthy women between 40 and 60 were assigned to either the computer-based intervention group (CBIG) or usual care group (UCG). Measures of health beliefs and calcium and vitamin D intake were obtained at baseline, 8 and 14 weeks, and 6 months. An interaction effect was observed for self-efficacy and approached significance for goal congruence. The CBIG had higher level of calcium intake at 14 weeks than women in the UCG when analyzed using intention to treat. Self-efficacy predicted calcium intake.

Using Content-based Humorous Cartoons in Learning Materials to Improve Students’ Reading Rate, Comprehension and Motivation: It is a Wrong Technique?

Can content-based humorous cartoons be integrated in texts in teaching and learning materials to improve students’ reading rate, comprehension and motivation? Previous studies have reported inconsistent results. To identify the effects of content-based humorous cartoons in reading materials, a between-subjects repeated-measures experimental study and a follow-up survey study were conducted. The majority of the students opined that the illustrations had positive impacts on their reading. Results of the experimental study indicate that the illustrations had significantly increased rate, comprehension and motivation of the students. The findings provide supportive evidences for the Dual Coding Theory and Relief Theory of Laughter.

Effects of noise in high schools on pupils' perceptions and performance

A recent project has investigated acoustical conditions in secondary (high) schools, and examined the effects of a poor acoustic environment on teaching and learning of 11- to 16-year-olds. Around 2600 pupils from suburban secondary schools in England responded to an online questionnaire concerning the acoustic environment in their schools. The questionnaire data highlighted the differential effects of noise reported by more vulnerable learners. A repeated measures experimental study involving 572 pupils examined reading performance under two different classroom noise simulations. Results revealed a complex pattern reflecting noise levels, time of testing and measure of reading performance used. Reading text while exposed to classroom noise of 70 dB resulted in quicker reading but less accuracy in measures of reading comprehension compared with performance in 50 dB. The data further suggested that the pupils were not processing the text as deeply as was evident from their reduced lexical learning. There were also interactions with time of testing highlighting the importance of examining the effects of chronic exposure in addition to single session experimental testing. The test results show that capturing the effects of noise on pupils’ learning in realistic classroom environments raises a number of methodological and analytical problems.

Effects of two hospital bed design features on physical demands and usability during brake engagement and patient transportation: A repeated measures experimental study

Background Work-related musculoskeletal disorders (WMSDs) are prevalent among healthcare workers worldwide. While existing research has focused on patient-handling techniques during activities which require direct patient contact (e.g., patient transfer), nursing tasks also involve other patient-handling activities, such as engaging bed brakes and transporting patients in beds, which could render healthcare workers at risk of developing WMSDs. Objectives Effectiveness of hospital bed design features (brake pedal location and steering-assistance) was evaluated in terms of physical demands and usability during brake engagement and patient transportation tasks. Design Two laboratory-based studies were conducted. In simulated brake engagement tasks, three brake pedal locations (head-end vs. foot-end vs. side of a bed) and two hands conditions (hands-free vs. hands-occupied) were manipulated. Additionally, both in-room and corridor patient transportation tasks were simulated, in which activation of steering-assistance features (5th wheel and/or front wheel caster lock) and two patient masses were manipulated. Participants Nine novice participants were recruited from the local student population and community for each study. Methods During brake engagement, trunk flexion angle, task completion time, and questionnaires were used to quantify postural comfort and usability. For patient transportation, dependent measures were hand forces and questionnaire responses. Results Brake pedal locations and steering-assistance features in hospital beds had significant effects on physical demands and usability during brake engagement and patient transportation tasks. Specifically, a brake pedal at the head-end of a bed increased trunk flexion by 74–224% and completion time by 53–74%, compared to other pedal locations. Participants reported greater overall perceived difficulty and less postural comfort with the brake pedal at the head-end. During in-room transportation, participants generally reported “Neither Low nor High” physical demands with the 5th wheel activated, compared to “Moderately High” physical demands when the 5th wheel was deactivated. Corridor transportation was similarly reported to be easier when a steering-assistance feature (the 5th wheel or front caster lock) was activated. Conclusions Braking and steering-assistance features of hospital beds can have important effects on task efficiency and physical demands placed on healthcare workers. Selection of specific designs may thus be able to improve productivity and contribute to a reduction in WMSDs risk among healthcare workers.

Immediate effect of treadmill walking practice versus overground walking practice on overground walking pattern in ambulatory stroke patients: an experimental study

Objective: To determine whether 10 minutes of treadmill walking had a different effect on overground walking pattern compared with 10 minutes of overground walking in newly ambulatory stroke patients. Are any changes influenced by walking ability? Design: A within-participant, repeated measures experimental study was conducted. Each participant carried out 10 minutes of overground walking practice followed by 10 minutes of treadmill walking practice at matched heart rate on separate days. Setting: An inpatient rehabilitation facility. Subjects: Twenty-one participants receiving inpatient rehabilitation following stroke. Measures: Overground walking pattern was measured as linear and angular kinematics using GAITRite and a two-dimensional webcam application respectively. Results: Following treadmill walking practice, there was 6 degrees (95% confidence interval (CI) 2 to 10) more knee extension at heel strike during overground walking than following overground walking practice. Poorer walkers increased non-paretic limb step length following treadmill walking practice more than those with better walking ability (mean difference 2.2 cm, 95% CI 0 to 5). Conclusions: Ten minutes of treadmill walking practice resulted in a similar overground walking pattern compared with overground walking practice in newly ambulatory stroke patients undergoing rehabilitation, regardless of walking ability.

Increasing intensity during treadmill walking does not adversely affect walking pattern or quality in newly-ambulating stroke patients: an experimental study

Does walking on a treadmill at increasing intensities adversely affect walking pattern or reduce walking quality during treadmill walking? Are any changes influenced by walking ability? A within-participant, repeated measures experimental study. 18 individuals with a first stroke who were undergoing inpatient rehabilitation. Walking on a treadmill at intensities of 30%, 40%, 50% and 60% heart rate reserve in the one session. During treadmill walking practice, walking pattern was measured as linear and angular kinematics while walking quality was measured using the Rivermead Gait Analysis scale and a visual analogue scale. Walking on the treadmill at 60% heart rate reserve, step length of the paretic limb was 0.05 m (95% CI 0.01 to 0.10) longer, step length of the non-paretic limb was 0.09 m (95% CI 0.05 to 0.12) longer, and hip flexion at mid swing was 4 degrees (95% CI 1 to 6) greater than at 30% heart rate reserve. At 60% heart rate reserve, hip and knee extension at mid stance were respectively 3 and 4 degrees more flexed than at 30% heart rate reserve. Walking ability did not affect changes in walking pattern. Walking quality did not change with increasing treadmill intensity. Walking on a treadmill at increasing intensity did not adversely affect walking pattern or reduce walking quality in newly-ambulating stroke patients. This study adds some support for the inclusion of walking on a treadmill at higher intensities in rehabilitation for newly-ambulating stroke patients.