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Gallow S, Beard J, McGinley J, Olver J, Williams G. Cardiorespiratory fitness assessment and training in the early sub-acute phase of recovery following traumatic brain injury: a systematic review. Brain Inj 2024:1-12. [PMID: 38828871 DOI: 10.1080/02699052.2024.2361638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 05/27/2024] [Indexed: 06/05/2024]
Abstract
OBJECTIVES To examine the safety of cardiorespiratory fitness (CRF) assessment and training in the early sub-acute phase of recovery (≤3 months) following moderate-to-extremely severe traumatic brain injury (TBI). METHODS A systematic review was completed in accordance with the PRISMA guidelines. Studies investigating adults and adolescents ≥15 years with moderate-to-extremely severe TBI were considered for inclusion. The methodological quality of the included studies was evaluated according to the McMaster Guidelines for Critical Review Form - Quantitative Studies. RESULTS Eleven studies with a total of 380 participants were included in the review. Adverse events (AEs) and symptom monitoring were poorly reported. Only four studies reported on the occurrence of AEs, with a total of eight AEs reported. Three of the reported AEs were concussion-like symptoms with no further exercise-induced symptom exacerbation reported. No serious AEs were reported. CONCLUSION There is no evidence to suggest that CRF assessment and training is unsafe in the early sub-acute phase of recovery following moderate-to-extremely severe TBI. However, despite the low AE and symptom exacerbation rates identified, a timeframe for safe commencement was unable to be established due to poor reporting and/or monitoring of exercise-induced symptoms and AEs in the current literature.
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Affiliation(s)
- Sara Gallow
- Department of Rehabilitation and Mental Health, Epworth HealthCare, Melbourne, Australia
- Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
| | - Jack Beard
- Department of Rehabilitation and Mental Health, Epworth HealthCare, Melbourne, Australia
| | - Jennifer McGinley
- Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
| | - John Olver
- Department of Rehabilitation and Mental Health, Epworth HealthCare, Melbourne, Australia
- Department of Rehabilitation, Epworth Monash Rehabilitation Medicine Unit, Melbourne, Australia
| | - Gavin Williams
- Department of Rehabilitation and Mental Health, Epworth HealthCare, Melbourne, Australia
- Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
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Hassett L. Physiotherapy management of moderate-to-severe traumatic brain injury. J Physiother 2023; 69:141-147. [PMID: 37286387 DOI: 10.1016/j.jphys.2023.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 05/17/2023] [Indexed: 06/09/2023] Open
Affiliation(s)
- Leanne Hassett
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Implementation Science Academy, Sydney Health Partners, Sydney, Australia.
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BEATVIC, a body-oriented resilience therapy for individuals with psychosis: Short term results of a multi-center RCT. PLoS One 2022; 17:e0279185. [PMID: 36542671 PMCID: PMC9770373 DOI: 10.1371/journal.pone.0279185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Individuals with a psychotic disorder are at an increased risk of victimization, but evidenced-based interventions are lacking. AIMS A body-oriented resilience therapy ('BEATVIC') aimed at preventing victimization was developed and its effectiveness was assessed in a multicenter randomized controlled trial. METHODS 105 people with a psychotic disorder were recruited from six mental health centers. Participants were randomly allocated to 20 BEATVIC group sessions (n = 53) or befriending group sessions (n = 52). Short term effects on risk factors for victimization (e.g. social cognitive deficits, inadequate interpersonal behavior, low self-esteem, internalized stigma, aggression regulation problems), physical fitness and secondary outcomes were expected. At six-month follow-up, the effect on victimization (either a 50% reduction or an absence of victimization incidents) was examined. RESULTS Intervention-dropout was 28.30% for BEATVIC and 39.62% for befriending. In both conditions the majority of participants (60.5% BEATVIC vs 62.9% befriending) showed a reduction or absence of victimization incidents at six months follow-up, which was not significantly different according to condition. Multilevel analyses revealed no main effect of time and no significant time x group interaction on other outcome measures. Per protocol analyses (participants attending ≥ 75% of the sessions) did not change these results. CONCLUSIONS Although a reduction or absence of victimization was found at short term follow-up for the majority of participants, BEATVIC was not more effective than the active control condition. No short-term additional effects on risk factors of victimization were found. Analysis of the data at 2-year follow-up is warranted to investigate possible effects in the long-term. TRIAL REGISTRATION NUMBER Current Controlled Trials: ISRCTN21423535.
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The Effect of Physical Exertional Testing on Postconcussion Symptom Scale Scores in Male and Female High School Students. Pediatr Exerc Sci 2022; 35:70-76. [PMID: 35894897 DOI: 10.1123/pes.2021-0156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 03/10/2022] [Accepted: 05/31/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE Symptom scores commonly measured following concussion were compared between male and female adolescents with (Hx+) and without (Hx-) a history of concussion, pre and post physical exertion testing. METHODS Eighty (males [n = 60; Hx+ = 19], female [n = 20; Hx+ = 5]) high school students (ages 15-17 y) completed the Buffalo Concussion Treadmill Test once and the modified shuttle run test twice. Symptom scores were collected using the 22-point Symptom Evaluation Scale on the Sport Concussion Assessment Tool (version 5) immediately pre and post physical exertion testing. RESULTS The symptoms most reported during preexertional testing were fatigue/low energy, feeling slowed down, and nervous/anxious, whereas feeling slowed down, fatigue/low energy, "pressure in head" (males only), and headache (females only) were most frequently reported during postexertion testing. CONCLUSION An understanding of the common exertion-related symptoms at baseline in a laboratory or field-based setting in adolescents may be advantageous for clinicians as they manage individual recovery postconcussion. This is particularly important during an adolescent's recovery and return to play when exertional testing may be implemented, especially since symptoms were reported pre and post exertional testing in both males and females regardless of concussion history.
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Pediatric Traumatic Brain Injury and Exercise Medicine: A Narrative Review. Pediatr Exerc Sci 2019; 31:393-400. [PMID: 30955443 DOI: 10.1123/pes.2017-0286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 01/10/2019] [Accepted: 01/28/2019] [Indexed: 11/18/2022]
Abstract
The multidisciplinary field of pediatric traumatic brain injury (TBI) and exercise medicine is of growing importance. There is active study into the diagnostic and therapeutic potential of exercise in pediatric TBI as well as the effects of TBI on postinjury fitness. With the evidence-based growing, a literature review can help establish the state of the science and inform future research. Therefore, the authors performed a narrative review (based on a search of 6 health sciences databases) to summarize evidence on pediatric TBI and cardiorespiratory fitness, muscular fitness and neuromotor control, and obesity. To date, studies related to cardiorespiratory fitness have centered on exercise tolerance and readiness to return to play, and indicate that protracted rest may not facilitate symptom recovery; this suggests a role for exercise in concussion management. Furthermore, strength and gait may be impaired following pediatric brain injury, and interventions designed to train these impairments may lead to their improvement. Pediatric brain injury can also lead to changes in body composition (which may be related to poorer cognitive recovery), but additional research is required to better understand such associations. This narrative review of pediatric TBI and exercise medicine can serve as a reference for researchers and clinicians alike.
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Fadida Y, Shapira-Vadler O, Spasser R, Frenkel-Toledo S. Reproducibility and smallest real differences of walking and Energy Expenditure Index in children and adolescents with an acquired brain injury. NeuroRehabilitation 2019; 45:19-24. [PMID: 31403952 DOI: 10.3233/nre-192716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Reliable evaluation is of utmost importance to the therapist and the patient. There is no data about the test-retest reproducibility of 6-Minute Walk Test (6MWT) and Energy Expenditure Index (EEI) for children and adolescents with an Acquired Brain Injury (ABI) in the sub-acute phase. OBJECTIVE To determine test-retest reproducibility and smallest real differences (SRDs) of the 6MWT and EEI in children and adolescents with an ABI during rehabilitation in the sub-acute phase. Our second aim was to assess the correlation between the objective measure, the EEI, and the subjective perception of physical exertion obtained by using the pictorial children's effort rating scale (PCERT). METHODS Twenty eight participants (12.5±4.3 years; 10 females) with an ABI in the sub-acute phase were asked to perform the 6MWT twice during their hospitalization. Heart rate was monitored during rest and throughout the 6MWT to calculate the EEI. Intra-class correlation coefficients (ICCs) and SRDs of the 6MWT and EEI were determined. RESULTS Test-retest reproducibility was excellent for the 6MWT (ICC = 0.98, SRD = 65.73 m) and EEI tests (ICC = 0.99, SRD = 0.65 beats/m). Excluding one participant who walked extremely slowly resulted in ICC = 0.97, SRD = 67.01 m for the 6MWT, and ICC = 0.91, SRD = 0.25 beats/m for the EEI. No significant correlations were found between the EEI and PCERT. CONCLUSIONS 6MWT and EEI are reliable measures in children and adolescents with an ABI during hospitalization in the sub-acute phase.
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Affiliation(s)
- Yahaloma Fadida
- Department of Physical Therapy, Loewenstein Rehabilitation Hospital, Raanana, Israel.,Department of Pediatric and Youth Rehabilitation, Loewenstein Rehabilitation Hospital, Raanana, Israel
| | - Orit Shapira-Vadler
- Department of Physical Therapy, Loewenstein Rehabilitation Hospital, Raanana, Israel.,Department of Pediatric and Youth Rehabilitation, Loewenstein Rehabilitation Hospital, Raanana, Israel
| | - Raluca Spasser
- Department of Pediatric and Youth Rehabilitation, Loewenstein Rehabilitation Hospital, Raanana, Israel
| | - Silvi Frenkel-Toledo
- Department of Physical Therapy, Faculty of Health Sciences, Ariel University, Ariel, Israel.,Department of Physical Therapy, Loewenstein Rehabilitation Hospital, Raanana, Israel
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Conway D, Ladlow P, Ferreira J, Mani-Babu S, Bennett AN. Cognitive functional therapy (CFT)-based rehabilitation improves clinical outcomes in UK military personnel with persistent low back pain. BMJ Mil Health 2019; 166:336-341. [DOI: 10.1136/jramc-2018-001136] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/08/2019] [Accepted: 01/10/2019] [Indexed: 11/03/2022]
Abstract
IntroductionLow back pain (LBP) has been reported as the most common reason for presentation to the Medical Centre in the British Military, and the most common re-referral for the same condition. In 2015, the UK Defence Medical Rehabilitation Centre (DMRC) adopted a cognitive functional therapy (CFT) approach to spinal rehabilitation in line with National Institute for Health and Care Excellence and military best practice guidelines. The aim of this study is to evaluate the functional and psychosocial outcomes of all patients with chronic LBP treated with CFT-based multidisciplinary rehabilitation at DMRC, Headley Court.MethodsA prospective observational service evaluation of British Military patients (n=238) with LBP who attended 3 weeks of inpatient multidisciplinary CFT-based programme from 2015 to the end of 2017 at DMRC was analysed. Functional outcomes include: multistage locomotion test (MSLT) and sit and reach test. Psychosocial outcomes include: Tampa Scale of Kinesiophobia, Oswestry Disability Index, Brief Pain Inventory (BPI), General Anxiety Disorder-7 and Patient Health Questionnaire-9.ResultsThere were significant improvements in endurance (MSLT), range of motion, kinesiophobia, pain-related lifestyle interference (BPI-Lifestyle), anxiety and depression (p≤0.001). However, no improvements in pain intensity (BPI-Intensity) were demonstrated (p>0.05).ConclusionAfter 3 weeks of CFT-based multidisciplinary rehabilitation, function and psychosocial health improved with symptoms of pain being less obtrusive to activities of daily activity. There were however no patient-reported reductions in pain intensity. The improvements demonstrated are indicative of outcomes that facilitate greater integration back to work or into society.
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The Adapted Physical Activity Program: A Theory-Driven, Evidence-Based Physical Activity Intervention for People with Brain Impairment. BRAIN IMPAIR 2018. [DOI: 10.1017/brimp.2018.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
People with brain impairments are less active than the general population and consequently have an increased risk of chronic disease. To increase activity requires interventions that are theory driven and evidence based. Here, we describe the adapted physical activity program (APAP), a physical activity promotion program with demonstrated efficacy in community dwelling adults with brain impairments. Distinguishing features of the APAP include the following: delivery in the participants home/or community environment and the utilisation of the principals of community-based rehabilitation; the assessment of each of the domains of the International Classification of Functioning, Disability and Health (ICF) (i.e., health conditions, impairments, activity limitations, participation restrictions and personal and environmental characteristics) to determine how they will impact physical activity adoption and maintenance; the incorporation of theory-based physical activity adoption and maintenance strategies; the utilisation of lifestyle physical activity programs (including client-centred selection of activities) and/or structured exercise programs (requiring principles of exercise prescription). It is anticipated that this program description will permit researchers and/or practitioners to implement the program, replicate its evaluation and/or translate the program into multi-professional rehabilitation settings.
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Surtees JE, Heneghan NR. General group exercise in low back pain management in a military population, a comparison with specific spine group exercise: a service evaluation. BMJ Mil Health 2018; 166:140-145. [PMID: 30377219 DOI: 10.1136/jramc-2018-001011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/14/2018] [Accepted: 09/16/2018] [Indexed: 11/04/2022]
Abstract
ObjectiveTo investigate whether general group exercise (GGE) offers the same outcomes compared with a specific spinal group exercise (SSGE) for chronic low back pain (CLBP) in a military population.DesignRetrospective service evaluation using routine service activity data.SettingA UK military rehabilitation centre.ParticipantsA total of 106 patients with CLBP.InterventionsThree-week intensive (5 days per week, 15-day intervention) rehabilitation course for patients with CLBP. Six SSGE groups (n=64); CLBP only. Six GGE groups (n=42); CLBP patients grouped with chronic lower limb (LL) injuries.Outcome measuresOswestry Disability Index (ODI), Numerical Pain-Rating Scores and the Modified Multi-Stage Fitness Test (Mod-MSFT). Long-term effects were measured by Medical Employment Standard (MES) status and physiotherapy follow-up at 3 and 12 months.ResultsA between-group analysis showed no significant difference in GGE compared with SSGE. Mean changes (SD) in pain were −2.71±2.35 and −1.20±1.99 (p=0.018), ODI were −3.6±5.7 and −4±8.5 respectively (p=0.649) and Mod-MSFT 28.4±30.8 and 29.7±31.7 respectively (p=0.792). At 3 months, a greater proportion of the GGE were having ongoing physiotherapy; GGE=50%, SSGE=30.2%, (p=0.016) although some differences were evident across MES with 32.5 % of GGE compared with 20.6 % of SSGE being medically fit with no restrictions. At 12 months, groups were largely comparable for follow-up physiotherapy and MES; 22.5% of GGE and 20.6% of SSGE continued to have physiotherapy input; 47.5% of GGE and 50.8% of SSGE were medically fit with no restrictions.ConclusionPatients with CLBP who completed a 3-week rehabilitation programme had comparable outcomes when grouped with patients with LL, although only improvements in pain in the GGE group achieved a meaningful change. Further evaluation of potential costs and savings to service costs is now required.
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Affiliation(s)
- Joanna E Surtees
- Primary Care Rehabilitation Facility, RAF Waddington, Lincoln, UK
| | - N R Heneghan
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, College of Life and Environmental Sciences, Birmingham, UK
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Ladlow P, Coppack RJ, Dharm-Datta S, Conway D, Sellon E, Patterson SD, Bennett AN. Low-Load Resistance Training With Blood Flow Restriction Improves Clinical Outcomes in Musculoskeletal Rehabilitation: A Single-Blind Randomized Controlled Trial. Front Physiol 2018; 9:1269. [PMID: 30246795 PMCID: PMC6139300 DOI: 10.3389/fphys.2018.01269] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 08/21/2018] [Indexed: 11/16/2022] Open
Abstract
Background: There is growing evidence to support the use of low-load blood flow restriction (LL-BFR) exercise in musculoskeletal rehabilitation. Purpose: The purpose of this study was to evaluate the efficacy and feasibility of low-load blood flow restricted (LL-BFR) training versus conventional high mechanical load resistance training (RT) on the clinical outcomes of patient’s undergoing inpatient multidisciplinary team (MDT) rehabilitation. Study design: A single-blind randomized controlled study. Methods: Twenty-eight lower-limb injured adults completed a 3-week intensive MDT rehabilitation program. Participants were randomly allocated into a conventional RT (3-days/week) or twice-daily LL-BFR training group. Outcome measurements were taken at baseline and 3-weeks and included quadriceps and total thigh muscle cross-sectional area (CSA) and volume, muscle strength [five repetition maximum (RM) leg press and knee extension test, isometric hip extension], pain and physical function measures (Y-balance test, multistage locomotion test—MSLT). Results: A two-way repeated measures analysis of variance revealed no significant differences between groups for any outcome measure post-intervention (p > 0.05). Both groups showed significant improvements in mean scores for muscle CSA/volume, 5-RM leg press, and 5-RM knee extension (p < 0.01) after treatment. LL-BFR group participants also demonstrated significant improvements in MSLT and Y-balance scores (p < 0.01). The Pain scores during training reduced significantly over time in the LL-BFR group (p = 0.024), with no adverse events reported during the study. Conclusion: Comparable improvements in muscle strength and hypertrophy were shown in LL-BFR and conventional training groups following in-patient rehabilitation. The LL-BFR group also achieved significant improvements in functional capacity. LL-BFR training is a rehabilitation tool that has the potential to induce positive adaptations in the absence of high mechanical loads and therefore could be considered a treatment option for patients suffering significant functional deficits for whom conventional loaded RT is contraindicated. Trial Registration: ISRCTN Reference: ISRCTN63585315, dated 25 April 2017.
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Affiliation(s)
- Peter Ladlow
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Headley Court, Epsom, United Kingdom.,Department for Health, University of Bath, Bath, United Kingdom
| | - Russell J Coppack
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Headley Court, Epsom, United Kingdom.,Department for Health, University of Bath, Bath, United Kingdom
| | - Shreshth Dharm-Datta
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Headley Court, Epsom, United Kingdom
| | - Dean Conway
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Headley Court, Epsom, United Kingdom
| | - Edward Sellon
- Imaging Department, Oxford University Hospitals, Oxford, United Kingdom
| | - Stephen D Patterson
- School of Sport, Health and Applied Science, St. Mary's University, London, United Kingdom
| | - Alexander N Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Headley Court, Epsom, United Kingdom.,Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, United Kingdom
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Ladlow P, Coppack RJ, Dharm-Datta S, Conway D, Sellon E, Patterson SD, Bennett AN. The effects of low-intensity blood flow restricted exercise compared with conventional resistance training on the clinical outcomes of active UK military personnel following a 3-week in-patient rehabilitation programme: protocol for a randomized controlled feasibility study. Pilot Feasibility Stud 2017; 3:71. [PMID: 29234504 PMCID: PMC5723055 DOI: 10.1186/s40814-017-0216-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 12/01/2017] [Indexed: 01/08/2023] Open
Abstract
Background A challenge for rehabilitation practitioners lies in designing optimal exercise programmes that facilitate musculoskeletal (MSK) adaptations whilst simultaneously accommodating biological healing and the safe loading of an injured limb. A growing body of evidence supports the use of resistance training at a reduced load in combination with blood flow restriction (BFR) to enhance hypertrophic and strength responses in skeletal muscle. In-patient rehabilitation has a long tradition in the UK Military, however, the efficacy of low intensity (LI) BFR training has not been tested in this rehabilitation setting. The aims of this study are to determine (1) the feasibility of a randomised controlled trial (RCT) investigating LI-BFR training in a residential, multidisciplinary treatment programme and (2) provide preliminary data describing the within and between-group treatment effects of a LI-BFR intervention and a conventional resistance training group in military personnel. Methods This is a single-blind randomised controlled feasibility study. A minimum of 28 lower-limb injured UK military personnel, aged 18 to 50 years, attending rehabilitation at the UK Defence Medical Rehabilitation Centre (DMRC) will be recruited into the study. After completion of baseline measurements, participants will be randomised in a 1:1 ratio to receive 3 weeks (15 days) of intensive multidisciplinary team (MDT) in-patient rehabilitation. Group 1 will receive conventional resistance training 3 days per week. Group 2 will perform twice daily LI-BFR training. Both groups will also undertake the same common elements of the existing MDT programme. Repeat follow-up assessments will be undertaken upon completion of treatment. Group 2 participants will be asked to rate their pain response to LI-BFR training every five sessions. Discussion The results will provide information on the feasibility of a full-scale RCT. Recommendations for an adequately powered study to determine the efficacy of LI-BFR training during in-patient rehabilitation can then be made. The study may also provide insights into the potential effectiveness of LI-BFR training as a novel exercise modality to induce muscle adaptations in the absence of high mechanical loading of the lower-limb. Trial registration ISRCTN Reference: ISRCTN 63585315 dated 25 April 2017.
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Affiliation(s)
- Peter Ladlow
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC), Headley Court, Epsom, Surrey UK.,Department for Health, University of Bath, Bath, UK
| | - Russell J Coppack
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC), Headley Court, Epsom, Surrey UK.,Department for Health, University of Bath, Bath, UK
| | - Shreshth Dharm-Datta
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC), Headley Court, Epsom, Surrey UK
| | - Dean Conway
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC), Headley Court, Epsom, Surrey UK
| | - Edward Sellon
- Imaging Department, Oxford University Hospitals, Oxford, UK
| | - Stephen D Patterson
- School of Sport, Health and Applied Science, St Mary's University, London, UK
| | - Alexander N Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC), Headley Court, Epsom, Surrey UK.,National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
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Coppack RJ, Bilzon JL, Wills AK, McCurdie IM, Partridge LK, Nicol AM, Bennett AN. Physical and functional outcomes following multidisciplinary residential rehabilitation for prearthritic hip pain among young active UK military personnel. BMJ Open Sport Exerc Med 2016; 2:e000107. [PMID: 27900174 PMCID: PMC5117069 DOI: 10.1136/bmjsem-2015-000107] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2016] [Indexed: 12/26/2022] Open
Abstract
Background There are no studies describing the clinical outcomes of a residential, multidisciplinary team (MDT) rehabilitation intervention for patients with prearthritic hip pain. The aim of this cohort study was to describe the functional and physical outcomes of multidisciplinary residential rehabilitation for UK military personnel with prearthritic hip pain. Methods Participants (N=40) with a mean age of 33 years referred to a specialist residential rehabilitation centre completed a comprehensive multidisciplinary residential intervention. The main outcome measures were mean pain, physical function (modified shuttle test (MST) and Y-balance test), hip range of motion (HROM) and a patient-reported outcome measure (The Copenhagen Hip and Groin Outcome Score, HAGOS). All scores for symptomatic hips were taken at baseline and post-treatment. Results There were improvements in the Y-balance test and HROM following rehabilitation. There were significant improvements in mean difference (T1-to-T2) for Y-balance scores (15.8 cm, 95% CI 10.7 to 20.9, p<0.001), HROM (6.5° increase in hip flexion, 95% CI 4.6 to 9.4, p<0.001) and hip internal rotation (4.6°, 95% CI 2.7 to 6.6, p<0.001). Scores for HAGOS, pain, MST and functional activity assessment showed no improvement. Conclusions Among UK military personnel with prearthritic hip pain, MDT residential rehabilitation resulted in improvements in a functional Y-balance test, hip flexion and internal rotation. The study suggests short-term benefits across some outcomes for the current UK military approach to MDT residential rehabilitation.
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Affiliation(s)
- Russell J Coppack
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC), Epsom, UK; Department for Health, University of Bath, Bath, UK
| | | | - Andrew K Wills
- School of Clinical Sciences, University of Bristol , Bristol , UK
| | - Ian M McCurdie
- Centre for Lower Limb Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) , Epsom , UK
| | - Laura K Partridge
- Centre for Lower Limb Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) , Epsom , UK
| | - Alastair M Nicol
- Centre for Lower Limb Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) , Epsom , UK
| | - Alexander N Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC), Epsom, UK; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
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Hassett L, Moseley A, Harmer A, van der Ploeg HP. The reliability, validity, and feasibility of physical activity measurement in adults with traumatic brain injury: an observational study. J Head Trauma Rehabil 2016; 30:E55-61. [PMID: 24721810 DOI: 10.1097/htr.0000000000000047] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the reliability and validity of the Physical Activity Scale for Individuals with a Physical Disability (PASIPD) in adults with severe traumatic brain injury (TBI) and estimate the proportion of the sample participants who fail to meet the World Health Organization guidelines for physical activity. DESIGN AND PARTICIPANTS A single-center observational study recruited a convenience sample of 30 community-based ambulant adults with severe TBI. PROTOCOL Participants completed the PASIPD on 2 occasions, 1 week apart, and wore an accelerometer (ActiGraph GT3X; ActiGraph LLC, Pensacola, Florida) for the 7 days between these 2 assessments. RESULTS The PASIPD test-retest reliability was substantial (intraclass correlation coefficient = 0.85; 95% confidence interval, 0.70-0.92), and the correlation with the accelerometer ranged from too low to be meaningful (R = 0.09) to moderate (R = 0.57). From device-based measurement of physical activity, 56% of participants failed to meet the World Health Organization physical activity guidelines. CONCLUSION The PASIPD is a reliable measure of the type of physical activity people with severe TBI participate in, but it is not a valid measure of the amount of moderate to vigorous physical activity in which they engage. Accelerometers should be used to quantify moderate to vigorous physical activity in people with TBI.
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Affiliation(s)
- Leanne Hassett
- Faculty of Health Sciences, Clinical and Rehabilitation Sciences Research Group (Drs Hassett and Harmer), The George Institute for Global Health, Sydney Medical School (Drs Hassett and Moseley), and Sydney School of Public Health (Dr van der Ploeg), The University of Sydney, Sydney, New South Wales, Australia; and Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU Medical Center, Amsterdam, the Netherlands (Dr van der Ploeg)
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The Aetiology of Reduced Cardiorespiratory Fitness Among Adults with Severe Traumatic Brain Injury and the Relationship with Physical Activity: A Narrative Review. BRAIN IMPAIR 2015. [DOI: 10.1017/brimp.2015.28] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Reduced cardiorespiratory fitness or cardiorespiratory deconditioning is a secondary physical impairment commonly reported to affect people after traumatic brain injury (TBI), both in the short- and long-term. Eleven studies have measured peak oxygen uptake${\rm ({\dot V}O}_{{\rm 2peak}} )$to evaluate fitness in this population. The mean (SD)${\rm \dot VO}_{{\rm 2peak}}$from these studies was 27.2 (6.7) mL.kg−1·min−1, which is markedly below the average fitness level of age-matched healthy individuals. The aetiology of cardiorespiratory deconditioning has not been well evaluated among people with TBI; however, studies on prolonged bed rest and studies on the acute consequences of TBI inform our current understanding. The primary aim of this paper is to present a model to describe the physiological factors contributing to the development of cardiorespiratory deconditioning among people with severe TBI. We propose that both central and peripheral factors contribute to reduced fitness, and that these changes occur because of both the initial brain damage and trauma sustained and the prolonged and initially extreme physical inactivity that is commonly experienced after this type of injury. Reduced fitness can significantly affect the ability to return to pre-injury activities. Given that reintegration into the community is a key goal of rehabilitation among people with TBI, interventions that can prevent or reverse reduced fitness need to be implemented.
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Cardiovascular Fitness Is Unrelated to Mobility Limitations in Ambulant People With Traumatic Brain Injury. J Head Trauma Rehabil 2013; 28:E1-7. [DOI: 10.1097/htr.0b013e318279536d] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Hassett LM, Moseley AM, Whiteside B, Barry S, Jones T. Circuit class therapy can provide a fitness training stimulus for adults with severe traumatic brain injury: a randomised trial within an observational study. J Physiother 2012; 58:105-12. [PMID: 22613240 DOI: 10.1016/s1836-9553(12)70090-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
QUESTIONS Can circuit class therapy provide sufficient exercise dosage (at least 20 minutes at ≥ 50% heart rate reserve or total caloric expenditure ≥ 300 kilocalories) to induce a cardiorespiratory fitness effect in adults with traumatic brain injury? Can feedback from heart rate monitors influence exercise intensity? DESIGN Randomised controlled trial within an observational study. PARTICIPANTS Fifty-three people with severe traumatic brain injury, of whom 40 progressed into the trial. INTERVENTION All participants undertook circuit class therapy. Participants allocated to the experimental group received exercise intensity feedback from a heart rate monitor and the control group received no feedback. OUTCOME MEASURES Proportion of participants exercising at ≥ 50% heart rate reserve for at least 20 minutes or expending ≥ 300 kilocalories during circuit class therapy. The primary outcome measure for the trial was the time spent in the heart rate training zone (ie, at ≥ 50% heart rate reserve) during the intervention and re-assessment periods. RESULTS Circuit class therapy provided sufficient cardiorespiratory exercise dosage for 28% (95% CI 18 to 42) of the cohort according to the heart rate reserve criteria and 62% (95% CI 49 to 74) according to the caloric criteria. Feedback did not increase the time in the training zone during the intervention (mean difference 4.8 minutes, 95% CI -1.4 to 10.9) or re-assessment (1.9 minutes, -4.4 to 8.3) periods. CONCLUSION The low intensity, long duration structure of circuit class therapy can provide sufficient exercise dosage for a fitness training effect for 62% of people with traumatic brain injury. Feedback from heart rate monitors does not necessarily influence exercise intensity. TRIAL REGISTRATION ACTRN12607000522415.
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Affiliation(s)
- Leanne M Hassett
- Liverpool Brain Injury Rehabilitation Unit, South Western Sydney Local Health District, Australia.
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Hassett LM, Tate RL, Moseley AM, Gillett LE. Injury severity, age and pre-injury exercise history predict adherence to a home-based exercise programme in adults with traumatic brain injury. Brain Inj 2011; 25:698-706. [DOI: 10.3109/02699052.2011.579934] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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