Energy Expenditure and Changes in Body Composition During Exercise-Based Rehabilitation.

Energy expenditure and changes in body composition during exercise-based rehabilitation.

J R Army Med Corps. 2013 Mar; 159(1): 30-34
Kristensen J

INTRODUCTION: Exercise-based rehabilitation programmes have formed the cornerstone of the treatment currently delivered at the Defence Medical Rehabilitation Centre (DMRC) based at Headley Court.Increased operational activity in recent years has meant a concomitant increase in the pressure on Defence rehabilitation resources and a greater need for effective rehabilitation strategies. The aim of this research was to assess the effects of exercise-based rehabilitation on energy expenditure and body composition. METHODS: A group of nine male volunteers (30±2.4 years) serving with the Armed Forces and suffering from a variety of musculoskeletal lower limb injuries underwent 17 days of exercise-based rehabilitation. Total daily energy expenditure (TEE) was assessed using a portable combined heart rate monitor/accelerometer (Actiheart).Changes in body composition were assessed using dual energy x-ray absorptiometry (DEXA). RESULTS: MeanTEE over the entire admission period was 2915±53 kcal/day with no significant difference in TEE observed between training week 1 (W1) and 2 (W2). However, a strong trend towards increased TEE in W1 was observed (p=0.06). No significant change was observed in fat mass (FM), lean body mass (LBM) or body-fat percentage despite the exercise-based rehabilitation programme. CONCLUSIONS: These results suggest that 17 days of exercise-based rehabilitation is insufficient to observe significant changes in body composition, despite high energy expenditure. HubMed – rehab


The safety and efficacy, and recommendations for the use of biologic drugs in the UK military rheumatology population.

J R Army Med Corps. 2013 Mar; 159(1): 8-14
Bennett AN, Green AD, Rees J, Jones T, Harris D, Etherington J

Inflammatory arthritis is a significant cause of morbidity in the military. In particular the sero-negative spondyloarthritides, which include ankylosing spondylitis, psoriatic arthritis, reactive arthritis, inflammatory bowel disease related arthritis and undifferentiated spondyloarthritis, are especially prevalent in the young male phenotype, which is common in the Armed Forces. It is estimated that there are more than 1500 patients in the Armed Forces with spondyloarthritis alone, based on the prevalence in the general population of approximately 1%. Inflammatory arthritides are eminently treatable, especially with the development and widespread use of biologic drugs such as anti-Tumour Necrosis Factor (TNF) therapy. The use of these drugs can deliver patients an exceptionally good outcome leading to symptom control and normal function in many cases. Initial concerns regarding safety and side effects of anti-TNF drugs have been allayed by the evidence provided from comprehensive national databases developed over the last 10 years. With early diagnosis and prompt treatment military patients can complete a full career including deployment with only minor limitations. This paper reviews the burden of inflammatory arthritis in the armed services, its management and outcome in this population, the evidence for the safety of anti-TNF treatments and the recommendations for employability and deployability for service personnel. HubMed – rehab


The functional activity assessment: a validated PROM, unreliable in the hands of clinicians.

J R Army Med Corps. 2013 May 23;
Roberts AJ, Etherington J

OBJECTIVES: To examine the validity of the clinician-assessed version of a military occupational outcome measure (the functional activity assessment; FAA) and to compare the validity with the self-assessed version. METHODS: The relationship between the clinician-assessed FAA and the SF-36 and Physical Workload Questionnaire was examined in 192 service personnel with musculoskeletal injuries. Concurrent validity was checked by comparing actual medical category with the FAA. RESULTS: Clinicians preferentially chose an FAA grade of 2 (56% of all grades). The clinician-assessed FAA was significantly correlated with all measured variables in the expected direction. The performance of the regression models did not fully support construct validity. The discriminative ability of the models was poor. CONCLUSIONS: The clinician-assessed FAA is a less valid measure than its self-assessed counterpart. Use of the patient-reported FAA outcome measure is recommended. HubMed – rehab


A Comparison of the Functional Independence Measure and Morse Fall Scale as Tools to Assess Risk of Fall on An Inpatient Rehabilitation.

Rehabil Nurs. 2013 May 29;
Forrest GP, Chen E, Huss S, Giesler A

PURPOSE: The purpose of this study was to determine if the Functional Independence Measure (FIM) is as useful as the Morse Fall Scale in determining which patients admitted to an inpatient rehabilitation facility (IRF) are at highest risk for fall. METHOD: Review of the charts of all patients admitted to an IRF in calendar year 2010. FINDINGS: Low scores on the FIM are as useful as high scores on the MFS in suggesting that a patient is at high risk for fall. CONCLUSIONS AND CLINICAL RELEVANCE: Nursing staffs that use the FIM to comply with Centers for Medicare and Medicaid Services (CMS) documentation requirements likely do not benefit by also evaluating and documenting the patients’ score on the MFS. HubMed – rehab