Hong Kong Physiotherapy Journal

Background: The impact of residential setting on the performance of older adults on commonly used instruments of mobility has not been closely investigated.

Objective: This study aimed to (1) explore whether mobility test performance differed between those who lived in urban and rural communities, and (2) report preliminary reference values for these tests according to residential setting.

Methods: The study used a descriptive design. Individuals who were aged 60 years and above, had no significant disability, and resided in urban and rural areas in the Philippines ($n=180$), participated in the study. Researchers measured mobility performance using the 10-Meter Walk Test (10MWT) (both comfortable gait velocity (CGV) and fast gait velocity (FGV)), Five Times Sit to Stand Test (FTSST), and Six-Minute Walk Test (6MWT). Preliminary reference values for the mobility tests were presented as means, standard deviations, and 95% confidence intervals. Scores were compared based on residential setting (urban versus rural).

Results: Urban-dwellers scored consistently better compared to their rural counterparts on the CGV, FGV, FTSST, and 6MWT using independent samples $t$-test ($p<0.001$). Data were further divided according to age and sex, and comparison of the mobility test scores between urban- and rural-dwellers within each subgroup showed similar differences ($p<0.01$).

Conclusion: Results provide preliminary evidence for the influence of residential setting on the mobility test performance of Filipino older adults. The study provides a good starting point for confirmatory research with a representative sample to (1) illustrate differences in mobility performance according to residential setting, (2) investigate how specific factors associated with residential settings contribute to differences in mobility performance, and (3) determine the extent to which clinicians should consider an older person’s residential setting when interpreting mobility test results.

Background: Physiotherapists play a key role in sports injury rehabilitation within the sports healthcare team. A strong athlete–physiotherapist relationship is necessary for effective treatment and shaping of athletes’ expectations of injury rehabilitation. Hence, it is necessary to factor the injured athletes’ expectations in structuring a rehabilitation program.

Objective: The aim of this study was to determine athletes’ expectations about physiotherapy in sports injury rehabilitation.

Methods: We performed a cross-sectional survey in which data was collected using the expectation about athletic training (EAAT) questionnaire from 120 recruited athletes of different sporting disciplines. Percentages, means and standard deviations of the expectation scores were computed. Associations between socio-demographic characteristics and athletes’ expectations of physiotherapy in sports injury rehabilitation were analyzed with the chi-square test. Differences between the athletes’ expectations of physiotherapy and demographic characteristics were also analyzed with Kruskal–Wallis and Mann–Whitney tests.

Results: The study revealed that there was no significant difference ($p>0.05$) between gender, injury type, physiotherapy experience and mental skills experience and the athletes’ expectations. There was a significant difference ($p<0.05$) between competition level and athletes’ expectations.

Conclusion: It was concluded that athletes in the Greater Accra Region have high expectations of physiotherapy in injury rehabilitation; thus sports physiotherapists would need to enhance their communication with athletes which may also help them better understand the risks, benefits, timeline and rehabilitation approach.

Background: Many patients after acute stage of stroke are present with abnormal gait pattern due to weakness or hypertonicity of the affected limbs. Facilitation of normal gait is a primary goal of rehabilitation on these patients.

Objective: We aimed to investigate whether walking assist device with auxiliary illuminator (quad-cane with laser) providing visual feedback during ambulation could improve parameters of gait cycle immediately among patients with subacute and chronic stroke.

Methods: This was a cross-sectional study and 30 participants (male 23, female 7, group 1) with mean age $60.20\pm 11.12$ years were recruited. Among them, 22 used ankle-foot orthosis [(AFO), group 2] and 8 did not use AFO (group 3) at usual walking. All the participants walked along a strait corridor with even surface for 20m without and with using a quad-cane with laser, respectively. A gait analyzer (Reha-Watch1 system) was used to measure the changes of the parameters of gait cycle, including stride length, cadence, gait speed, stance phase, swing phase, duration of single support and double support, the angle between toes and the ground at the time of toe-off (the toe-off angle) and the angle between calcaneus and the ground at the time of heel-strike (the heel-strike angle), before and with the use of a quad-cane with laser.

Results: The increase in the heel-strike angle reached a significant difference in groups 1 2, and 3 ($p=0.02,<0.01$, and $=0.05$, respectively). However, the stride length, the gait speed, the cadence, percentage of the stance phase, swing phase, single-support phase, and double-support phase in a gait cycle, and the toe-off angle showed no significant change with the use of quad-cane with laser.

Conclusion: Patients after acute stroke had an immediate and significant increase in the heel-stroke angle by using a quad-cane with laser during ambulation, which might help the patients to reduce knee hyperextension moment and lessen the pressure of heel at loading phase.

Background: The cut-off values of walking velocity and classification of functional mobility both have a role in clinical settings for assessing the walking function of stroke patients and setting rehabilitation goals and treatment plans.

Objective: The present study investigated whether the cut-off values of the modified Rivermead Mobility Index (mRMI) and walking velocity accurately differentiated the walking ability of stroke patients according to the modified Functional Ambulation Category (mFAC).

Methods: Eighty two chronic stroke patients were included in the study. The comfortable/maximum walking velocities and mRMI were used to measure the mobility outcomes of these patients. To compare the walking velocities and mRMI scores for each mFAC point, one-way analysis of variance and the post-hoc test using Scheffe’s method were performed. The patients were categorized according to gait ability into either $\mathrm{\text{mFAC}}=\mathrm{\text{VII}}$ or mFAC$\le$VI group. The cut-off values for mRMI and walking velocities were calculated using a receiver-operating characteristic curve. The odds ratios of logistic regression analysis (Wald Forward) were analyzed to examine whether the cut-off values of walking velocity and mRMI can be utilized to differentiate functional walking levels.

Results: Except for mFACs III and IV, maximum walking velocity differed between mFAC IV and mFAC V $(p<0.01)$, between mFAC V and mFAC VI $(p<0.001)$, and between mFAC VI and mFAC VII $(p<0.05)$. The cut-off value of mRMI is $>26.5$ and the area under the curve is 0.87, respectively; the cut-off value for comfortable walking velocity is $>0.77$m/s and the area under the curve is 0.92, respectively; also, the cut-off value for maximum walking velocity is $>0.92$m/s and the area under the curve is 0.97, respectively. In the logistic regression analysis, the maximum walking velocity $(>0.92$m/s, $\mathrm{\text{OR}}=22.027)$ and mRMI $(>26.5$ scores, $\mathrm{\text{OR}}=10.283)$ are able to distinguish $\mathrm{\text{mFAC}}=\mathrm{\text{VII}}$ from mFAC$\le$VI.

Conclusion: The cut-off values of maximum walking velocity and mRMI are recommended as useful outcome measures for assessing ambulation levels in chronic stroke patients during rehabilitation.

Background: Knee osteoarthritis (KOA) is a common degenerative articular disease that causes disability and poor quality of life (QoL) of the individuals. Electrotherapeutic agents such as therapeutic ultrasound (US), interferential current (IFC), and infrared radiation are used in the treatment. It is not clear which of these agents is the best in improving these variables.

Objective: The study aimed to compare the effects of the combined application of US and IFC therapies and infrared radiation on pain, functional activities, and QoL in people with KOA.

Methods: In a randomized controlled study, 60 participants were randomized into two groups, the combination therapy group (CTG) and the infrared radiation group (IRG). Each group received 15-min treatment three times per week for 12 weeks. The visual analog scale (VAS) was used to assess the pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for functional activities and the Short Form Health Survey questionnaire for QoL.

Results: Participants in the CTG had a significant ($p<0.05$) reduction in pain and significant ($p<0.05$) improvement in functional activities and QoL compared to the IRG.

Conclusion: The results of this study support the use of the combination of IFC and US therapies to reduce pain and improve function and QoL for KOA patients.

Objective: This study investigates the relationships between the Multi-Directional Reach Test (MDRT) and lower extremity strength in typical children.

Methods: The MDRT including forward, backward, leftward, and rightward directions was measured in 60 children aged between 7 and 12 years old with typical development. The lower extremity muscle groups were measured using a hand-held dynamometer.

Results: The reaching score in each direction had positive relationships with the strengths of several lower extremity muscle groups ($r=0.26$ to $0.52,p<0.05$). Only the strengths of the hip flexor and knee flexor muscles significantly correlated with the MDRT scores in all directions ($r=0.26$ to $0.50,p<0.05$).

Conclusion: This study highlights the strength of the hip and knee flexor muscle groups as being important domain to control balance in all directions. These findings may be used for therapists in planning a balance program to improve the limits of stability.